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Update on guidelines for acute stroke treatment by the Croatian society for neurovascular disorders of the Croatian medical association and the Croatian stroke society
No full textCilj ovih smjernica bio je predati najnovije, sistematizirane spoznaje kliničarima koji se bave zbrinjavanjem odraslih bolesnika s akutnim ishemijskim moždanim udarom. Preveli smo Američke smjernice za liječenje akutnog ishemijskog moždanog udara, koje su izdane 2018. godine od American Heart Association (AHA) i American Stroke Association (ASA) s ciljem prilagodbe hrvatskom zakonodavstvu i zdravstvenom sustavu. Članovi radne skupine Hrvatskog društva za neurovaskularne poremećaje Hrvatskog liječničkog zbora i Hrvatskog društva za moždani udar usmjerili su posebnu pozornost na pregled dosadašnjih spoznaja i prilagodili ih aktualnom stanju u nacionalnom zdravstvenom sustavu kako bi se postiglo optimalno zbrinjavanje bolesnika s akutnim ishemijskim moždanim udarom u Hrvatskoj. Ove smjernice obuhvaćaju prehospitalnu skrb, hitnu evaluaciju te liječenje intravenskom i intraarterijskom terapijom uključujući mjere sekundarne prevencije prigodom inicijalne hospitalizacije u odraslih pacijenata s akutnim moždanim udarom.The aim of these guidelines is to provide an update and comprehensive review of the recent literature for clinicians treating adult patients with acute stroke. We translated American guidelines for the acute ischemic stroke treatment, published in 2018 by the American Heart Association and American Stroke Association, and adapted these guidelines to the Croatian legislation, health insurance policy and standards of health care in Croatia. Members of the Croatian Society for Neurovascular Disorders of the Croatian Medical Association and the Croatian Stroke Society writing group evaluated and adjusted American guidelines to specifi cities of the Croatian health care system in order to improve the quality of stroke management in Croatia. These guidelines include pre-hospital care, urgent evaluation and treatment with intravenous and intra-arterial therapy, as well as the secondary prevention measures during initial hospitalization in adult acute stroke patients
Dabigatran for Prevention of Stroke after Embolic Stroke of Undetermined Source
No full textBACKGROUND: Cryptogenic strokes constitute 20 to 30% of ischemic strokes, and most cryptogenic strokes are considered to be embolic and of undetermined source. An earlier randomized trial showed that rivaroxaban is no more effective than aspirin in preventing recurrent stroke after a presumed embolic stroke from an undetermined source. Whether dabigatran would be effective in preventing recurrent strokes after this type of stroke was unclear.
METHODS: We conducted a multicenter, randomized, double-blind trial of dabigatran at a dose of 150 mg or 110 mg twice daily as compared with aspirin at a dose of 100 mg once daily in patients who had had an embolic stroke of undetermined source. The primary outcome was recurrent stroke. The primary safety outcome was major bleeding.
RESULTS: A total of 5390 patients were enrolled at 564 sites and were randomly assigned to receive dabigatran (2695 patients) or aspirin (2695 patients). During a median follow-up of 19 months, recurrent strokes occurred in 177 patients (6.6%) in the dabigatran group (4.1% per year) and in 207 patients (7.7%) in the aspirin group (4.8% per year) (hazard ratio, 0.85; 95% confidence interval [CI], 0.69 to 1.03; P=0.10). Ischemic strokes occurred in 172 patients (4.0% per year) and 203 patients (4.7% per year), respectively (hazard ratio, 0.84; 95% CI, 0.68 to 1.03). Major bleeding occurred in 77 patients (1.7% per year) in the dabigatran group and in 64 patients (1.4% per year) in the aspirin group (hazard ratio, 1.19; 95% CI, 0.85 to 1.66). Clinically relevant nonmajor bleeding occurred in 70 patients (1.6% per year) and 41 patients (0.9% per year), respectively.
CONCLUSIONS: In patients with a recent history of embolic stroke of undetermined source, dabigatran was not superior to aspirin in preventing recurrent stroke. The incidence of major bleeding was not greater in the dabigatran group than in the aspirin group, but there were more clinically relevant nonmajor bleeding events in the dabigatran group
IL-10 and IL-1B genetic polymorphism in cervical cancer
No full textCervical cancer is the fourth most common type of cancer for women worldwide. Human papillomavirus (HPV) is found in about 99% of cervical cancers. By the age of 50, approximately 80% of women have been infected with some type of HPV. The majority of women infected with the HPV virus do not develop cervical cancer. A small number of women do not clear the HPV virus and are considered to have a persistent infection. Disordered inflammation and immune response is an acknowledged risk factor for
cervical cancer development. Recent investigations showed that interaction between HPV and IL10 can lead to immunosuppressive environment in cervix, while T alel of IL-1B gene is correlated with chronic inflammation and persistent infection with HPV16/18
40 godina Knjižnice u Klinici za traumatologiju Kliničkog bolničkog centra Sestre milosrdnice u Zagrebu: 1979. - 2019.
Get PDFKnjižnica u Klinici za traumatologiju KBC Sestre milosrdnice u Draškovićevoj 19 u Zagrebu osnovana je u veljači 1979. godine u sastavu Traumatološke bolnice, utemeljene na istoj adresi 16. kolovoza 1948. pod nazivom Bolnica za traumatologiju u Zagrebu (Hranilović 1973). Prikupljanje fonda stručnih medicinskih knjiga i časopisa započelo je odmah nakon osnutka Bolnice, koja 1983. stječe status Klinike za traumatologiju Medicinskog fakulteta Sveučilišta u Zagrebu. U četrdeset godina djelovanja, Knjižnica je u nekoliko navrata mijenjala naziv. Osnovana kao Biblioteka Traumatološke bolnice u Zagrebu, u razdoblju od 1983. do 2010. godine djeluje pod nazivom Biblioteka Klinike za traumatologiju Zagreb. Nakon funkcionalnog spajanja bolničkih ustanova u svibnju 2010. Klinika za traumatologiju Zagreb ulazi u sastav Kliničkog bolničkog centra Sestre milosrdnice u Zagrebu (u nastavku KBCSM), Vinogradska 29. Biblioteka Klinike za traumatologiju Zagreb nastavlja s radom kao ogranak Središnje knjižnice KBC Sestre milosrdnice u Vinogradskoj 29 pod nazivom Knjižnica KBCSM - lokacija Draškovićeva 19. Tijekom trideset godina prije formalnog osnutka Knjižnice prikupljen je značajan broj stručnih inozemnih i domaćih knjiga te časopisa iz područja kirurgije, traumatologije,
ortopedije, anesteziologije i intenzivne medicine, fizikalne medicine i rehabilitacije te drugih srodnih medicinskih struka. Brigu o nabavi i rukovanju prikupljenom građom uglavnom su vodili mlađi liječnici uz pomoć administrativnog osoblja te podršku ravnatelja Bolnice. I prije i poslije službenog osnutka Knjižnice najveći dio fonda činile su inozemne knjige i inozemni stručni časopisi jer je u to doba broj medicinskih naslova na hrvatskom jeziku oskudan, osobito za područje traumatologije. Velik dio fonda bili su pokloni od strane ravnatelja ili starijih liječnika Bolnice. Osim toga, velik broj inozemnih naslova
knjiga i časopisa u fondu bio je uvjetovan činjenicom da su se brojni liječnici specijalisti kirurgije školovali ili educirali u inozemstvu pa su pratili literaturu na njemačkom, francuskom, ruskom i engleskom jeziku
Nutritivna procijena bioimpedancijom (bia) pacijenata s rakom želuca u perioperacijskom periodu
No full textGastric cancer is a ‘neglected cancer,’ with significant incidence (over 900 cases annually) and late-stage at the time of diagnosis in Croatia. Even in resectable cases, risk of malnutrition is high, and malnutrition-related to malignant disease presents a substantial problem in terms of compliance with treatment and complications during surgery. We retrospectively reviewed the patient records for patients operated for gastric cancer from January until December 2018. Data on sex, age, body mass index (BMI), complete preoperative blood count, postoperative recovery, and subsequent bioelectrical impedance analysis (BIA) measurements (preoperatively, on days 7, 14 and 30) were collected. All patients received nutritional support according to the Enhanced Recovery After Surgery (ERAS). Twenty-seven patients were operated for gastric cancer, eight were resected with curative intent (four total gastrectomies, one total gastrectomy with splenectomy, three distal gastrectomies and one local excision). Seven patients who had a resection were included in the perioperative nutritional protocol. All patients scored at risk according to Nutrition Score 2002 (NS2002). Two patients had tolerable initial BMIs and BIAs, only one patient with extremely low BMI and BIA had prolonged intensive care unit (ICU) stay and difficulties with peroral nutrition. Only the patients with tolerable initial values recovered those values postoperatively in the observed period but did not improve. Lean body mass is lost before surgery, and in the early postoperative period, it takes up to 3 months to compensate. However, in the late stage of the disease, routine ERAS nutritional protocol seems not to be enough. Perhaps, in gastric cancer, a more aggressive parenteral perioperative nutrition might be an option.Rak želuca je ‘zanemareni rak’, sa značajnom učestalošću (preko 900 slučajeva godišnje) i kasnom fazom u vrijeme dijagnoze u Hrvatskoj. Čak i u slučajevima koji se mogu resecirati, rizik od pothranjenosti je visok, a pothranjenost povezana s malignim bolestima predstavlja značajan problem u smislu pridržavanja liječenja i komplikacija tijekom liječenja. Od siječnja do prosinca 2018. retrospektivno smo pregledali podatke o bolesnicima koji su operirani zbog raka želuca. Podaci o spolu, dobi, indeksu tjelesne mase (BMI), potpunoj prijeoperacijskoj krvnoj slici, poslijeoperacijskom oporavku i mjerenjima bioimpedance (bioelectrical impedance analysis BIA), 7., 14. i 30. dan poslije operacije. Svi pacijenti dobili su nutritivnu potporu u skladu sa standardnim protokolom za oporavak (Enhanced Recovery After Surgery, ERAS). Dvadeset sedam bolesnika operirano je zbog raka želuca, 8 je resecirano s kurativnom namjerom (4 totalne gastrektomije, 1 totalna gastrektomija sa splenektomijom, 3 distalne gastrektomije i 1 lokalna ekscizija). Svi pacijenati koji su liječeni resekcijom bili su uključeni u perioperacijski prehrambeni protokol. Svi bolesnici su bili procijenjeni kao rizični za pothranjenost prema Nutrition Score 2002 (NS2002). Dvojica pacijenata su imala tolerabilne početne BMI-e i BIA-e, samo 1 bolesnik s ekstremno niskim vrijednostima BMI-a i BIA-e imao je produljeni boravak u jedinici intenzivnog liječenja i poteškoće s peroralnom prehranom. Samo su bolesnici s tolerabilnim početnim vrijednostima procijene ponovo dostigli te vrijednosti poslije operacije u promatranom razdoblju, ali ih nisu poboljšali. Mišićna masa se gubi prije operacije i u ranom poslijeoperacijskom razdoblju te je potrebno do 3 mjeseca za kompenzaciju. Međutim, u kasnom stadiju bolesti, rutinski ERAS protokol za prehranu se čini da nije dovoljan. Možda je kod raka želuca potrebna agresivnija parenteralna perioperacijska prehrana
Ishod trudnoće uz gestacijski dijabetes u usporedbi s indeksom tjelesne mase
No full textGestational diabetes involves disorder of glucose metabolism first diagnosed in pregnancy. Obese women undoubtedly have more often complications in reproductive age, such as fertility difficulties, spontaneous and recurrent miscarriages, premature births, and various obstetric and surgical complications related to the course of pregnancy, delivery and puerperium. Children of obese pregnant women are more likely to develop obesity in childhood and adulthood. We analyzed the outcome of 51 pregnancies in obese pregnant women and 50 pregnant women with normal body mass index. All women in both groups were diagnosed with gestational diabetes by the IADPSG criteria. We analyzed gestational age at delivery and mode of delivery, gestational weight gain, presence of concomitant diagnosis of gestational or chronic hypertension, difference in birth weight, and prevalence of hypertrophic newborns. There was no significant difference in gestational age at pregnancy termination and in the mode of delivery. There was a significant difference in gestational weight gain, number of pregnant women with hypertension, neonatal birth weight and number of hypertrophic children. Based on the data presented, we conclude that obesity is an unfavorable factor for pregnancy outcome. It also influences birth weight and fetal hypertrophy, as well as gestational weight gain.Gestacijski dijabetes podrazumijeva poremećaj metabolizma glukoze koji se prvi puta dijagnosticira u trudnoći, a njegova incidencija je u porastu. Pretile žene nedvojbeno imaju češće probleme i komplikacije u reproduktivnim godinama, što podrazumijeva teškoće pri zanošenju, spontane i habitualne pobačaje, prijevremene porođaje i različite opstetričke i kirurške komplikacije vezane za tijek trudnoće, porođaja i babinja. Djeca iz takvih trudnoća češće razvijaju pretilost u djetinjstvu kao i u odrasloj dobi. S obzirom na navedeno analizirali smo ishod trudnoća u 51 pretile trudnice i 50 trudnica s urednim indeksom tjelesne mase, pri čemu su sve trudnice (u objema skupinama) imale dijagnozu gestacijskog dijabetesa prema kriterijima IADPSG. Analizirali smo gestacijsku dob, način dovršenja trudnoće, prirast na težini trudnica, prisutnost istodobnih dijagnoza gestacijske ili kronične hipertenzije, razliku u težini novorođenčadi te učestalost hipertrofične novorođenčadi. Rezultati su pokazali da ne postoji statistički značajna razlika u gestacijskoj dobi kad je završena trudnoća niti u načinu dovršenja porođaja. Utvrđena je statistički značajna razlika u dobivenim kilogramima tijekom trudnoće, broju trudnica s hipertenzijom, porođajnoj masi novorođenčadi i broju hipertrofične djece. U zaključku, pretilost u trudnoći s gestacijskim dijabetesom je nepovoljan čimbenik za ishod trudnoće, porođajnu masu i prekomjeran rast novorođenčadi, kao i za prirast tjelesne mase trudnice tijekom trudnoće
Značajke liječenja i ishoda u starijih bolesnika s glioblastomom mozga: retrospektivna analiza niza slučajeva
No full textTreatment modalities affecting quality of life and survival in elderly brain glioblastoma patients are not well defined. A single-institution data were analyzed during a 3-year period to disclose prognostic difference in management related to age. Karnofsky Performance Scale (KPS), overall survival (OS), and adjuvant therapy were evaluated. The case group comprised of elderly patients (>75 years), while the control group included those of younger age (70 indicated longer overall survival. Statistically significant correlation was recorded in both the control (p=0.036) and case (p=0.0053) groups. Lower postoperative KPS was significantly correlated with shorter OS in elderly patients (p=0.023). The correlation between the extent of tumor resection and OS was statistically significant in younger patients only (p=0.04). Overall survival was significantly shorter in elderly patients regardless of the extent of tumor resection (p=0.0057). Adjuvant therapy was significantly associated with longer OS in both the case (p=0.032) and control (p=0.013) groups. Elderly population is a more endangered group of surgical brain glioblastoma patients having lower quality of life and shorter overall survival. The management protocol should be personalized for each individual case in this age group of patients to reduce postoperative complications and grant a satisfactory quality of life.Modaliteti liječenja od utjecaja na kvalitetu života i preživljavanje starijih bolesnika s glioblastomom još nisu jasno određeni. Kako bi se utvrdila prognostička razlika u primijenjenim oblicima liječenja u odnosu na dob bolesnika analizirani su podaci dobiveni trogodišnjim istraživanjem uzorka. Istraživani su sljedeći pokazatelji: Karnofskyjeva ljestvica (KPS), vrijeme ukupnog preživljavanja i primjena pomoćnog liječenja. Oglednu skupinu činili su stariji bolesnici (≥75 godina), a kontrolnu skupinu oni mlađe dobi (≤65 godina). Međusobno su uspoređivani istraživani parametri iz obje skupine bolesnika. Promatrano je 20 starijih i odgovarajući broj mlađih bolesnika. Prijeoperacijski KPS >70 upućivao je na dulje sveukupno preživljavanje. Statistički značajna korelacija zabilježena je u bolesnika kontrolne (p=0,036) i ogledne (p=0,0053) skupine. Niže poslijeoperacijske vrijednosti KPS bile su značajno povezane s kraćim vremenom preživljavanja u starijih bolesnika (p=0,023). Korelacija između opsežnosti tumorske resekcije i sveukupnog preživljavanja bila je statistički značajna samo u mlađoj dobnoj skupini (p=0,04). Vrijeme sveukupnog preživljavanja bilo je značajno kraće u starijih bolesnika neovisno o stupnju kirurške resekcije (p=0,0057). Primjena pomoćne terapije bila je značajno povezana s duljim sveukupnim preživljavanjem u oglednoj (p=0,032) i kontrolnoj (p=0,013) skupini. U zaključku, starija je populacija ugroženija skupina kirurških bolesnika s glioblastomom u kojih je smanjena kvaliteta života i skraćeno vrijeme sveukupnog preživljavanja. Stoga je potrebno protokol liječenja prilagoditi svakom pojedinom bolesniku iz ove dobne skupine kako bi se smanjio udio poslijeoperacijskih komplikacija i poboljšala kvaliteta života
Sinovijalna cista slabinske kralježnice: prikaz niza slučajeva i pregled strategija kirurškog liječenja
No full textLumbar spine synovial cysts are benign growths adjoining the facet joints that may induce low back pain, lumbar radiculopathy and neurological deficit. However, they are not well defined concerning their origin, cause and pathology, as well as available treatment strategies. The scope of different surgical procedures includes image-guided epidural steroid injection, direct cyst puncture by percutaneous epidural needle, spinal canal decompression and cyst resection, and spinal bone fusion with/without instrumentation. Hereby, we report institutional experience and discuss surgical strategies of lumbar spine synovial cyst treatment. Presenting symptoms, imaging findings and outcomes were retrospectively analyzed in 15 patients with lumbar spine synovial cyst, operated on during a one-year period. The leading presenting symptom was lumbar radicular pain, while the most commonly involved vertebral level was L5-S1. In a great majority of patients, a single-level interlaminectomy and cyst resection were performed. Most patients recovered without postoperative neurological and functional deficit, as well as surgery-related complications. No poor outcome was noticed in our series. Concerning our results and literature review, the optimal management for patients with symptomatic lumbar synovial cyst has to be highly personalized, which is essential to achieve a favorable outcome. Nonetheless, the best treatment strategy has yet to be affirmed.Sinovijalne ciste slabinske kralježnice benigne su ekspanzivne tvorbe smještene u blizini fasetnih zglobova koje mogu uzrokovati bol u donjim leđima, lumbalnu radikulopatiju i neurološki deficit. Međutim, ishodište i uzroci njihovog nastanka kao i moguće strategije liječenja ovakvih cista još su nedovoljno poznati. Raspon različitih postu-paka kirurškog liječenja uključuje radioskopski navođenu epiduralnu steroidnu infiltraciju, perkutanu punkciju ciste epiduralnom iglom, dekompresiju kralježničnog kanala i uklanjanje ciste te spinalnu koštanu fuziju s instrumentacijom ili bez nje. U ovom radu prikazujemo naša iskustva u liječenju slabinskih sinovijalnih cista i raspravljamo razli-čite strategije njihovog kirurškog liječenja. Retrospektivno su analizirani simptomi, nalazi dijagnostičkih pretraga i uspješnost liječenja u 15 operiranih bolesnika sa slabinskom sinovijalnom cistom tijekom jednogodišnjeg razdoblja. Vodeći prezentirajući simptom bila je slabinska radikularna bol, a najčešće zahvaćena razina bila je ona na L5-S1. Jednorazinska interlaminektomija i resekcija ciste učinjena je u velike većine bolesnika koji su se uspješno oporavili bez poslijeoperacijskog neurološkog i funkcijskog deficita, kao i bez nastanka komplikacija. Temeljem naših rezultata i pregledom literature zaključujemo da optimalno liječenje bolesnika sa sinovijalnom cistom slabinske kralježnice treba biti usmjereno svakom pojedinom bolesniku kako bi se osigurao uspješan ishod. Istodobno, najbolja strategija kirurškog liječenja još nije dovoljno potvrđena
Andreas Vesalius, the Predecessor of Neurosurgery: How his Progressive Scientific Achievements Affected his Professional Life and Destiny
No full textAndreas Vesalius, the father of modern anatomy and a predecessor of neuroscience, was a distinguished medical scholar and Renaissance figure of the 16th Century Scientific Revolution. He challenged traditional anatomy by applying empirical methods of cadaveric dissection to the study of the human body. His revolutionary book, De Humani Corporis Fabrica, established anatomy as a scientific discipline that challenged conventional medical knowledge, but often caused controversy. Charles V, the Holy Roman Emperor and King of Spain to whom De Humani was dedicated, appointed Vesalius to his court. While in Spain, Vesalius' work antagonized the academic establishment, current medical knowledge, and ecclesial authority. Consequently, his methods were unacceptable to the academic and religious status quo, therefore, we believe that his professional life—as well as his tragic death—was affected by the political state of affairs that dominated 16th Century Europe. Ultimately, he went on a pilgrimage to the Holy Land that jeopardized his life. While returning home, his ship was driven ashore on the Greek island of Zakynthos (Zante) where he became ill and suddenly died in 1564 at the age of 49. Vesalius' ideas helped free medicine from the limitations of the 16th Century and advanced scientific knowledge. His influence is still felt more than 500 years later. In this article, we acknowledge Vesalius' neuroanatomic contributions and we discuss the historical facts and political circumstances that influenced his scientific career and personal life, emphasizing the conditions of his pilgrimage to the Holy Land that led to his untimely death