Repository of the Sestre milosrdnice University Hospital Center
Not a member yet
502 research outputs found
Sort by
Intraoperacijska neurofiziologija i njezina uloga u sprječavanju poslijeoperacijskog deficita
No full textKorelacija biokemijskih indikatora stresa u slini i psiholoških indikatora
No full textSaliva is a complex body fluid that has various functions in the oral cavity. Central nervous system has the most important role in regulating salivation. Saliva as a sample is suitable for simplicity of sampling and because it contains analytes in the free active form. Stress is a condition in which the internal (psychophysical) balance of the body is disturbed. It activates the hypothalamic-pituitary axis, so salivary cortisol is a free cortisol indicator that correlates well with its serum value and reflects the free fraction that is biologically active. At the same time, stress conditions stimulate the sympathetic neuronal system causing change in the secretion of salivary α-amylase from salivary glands. The hypothesis of this study was that students with daily intensive physical activity are exposed to chronic stress compared to other students who have minimal physical activity. Th e study included 54 healthy volunteers, students of the University of Zagreb, divided into two groups. One volunteer group consisted of physically active volunteers (n=27) from the Faculty of Kinesiology (FK), and the other group consisted of physically inactive volunteers (n=27) from other faculties (OF). The subjects were fi rst administered a psychological test that consisted of two questionnaires, Quality of Life Questionnaire and Questionnaire of Stressful Styles, and then underwent sampling of saliva. By comparing biochemical and psychological indicators in relation to stress, it was concluded that the two groups of students were equalized and that there was no objective support for either group to be considered exposed to chronic stress. Despite the substantial differences in physical activity, there was no difference between the two student populations.Slina je tjelesna tekućina složenog sastava koja ima razne funkcije u usnoj šupljini. Središnji živčani sustav ima najznačajniju ulogu u regulaciji salivacije. Slina kao uzorak pogodna je zbog jednostavnosti uzorkovanja, a u njoj se analiti nalaze u slobodnom, tj. aktivnom obliku. Stres je stanje u kojem je poremećena unutarnja (psihofiziološka) ravnoteža organizma. Aktivira osovinu hipotalamus-hipofiza-kora nadbubrežne žlijezde pa je salivarni kortizol indikator slobodnog kortizola, dobro korelira sa serumskom vrijednošću i odražava slobodnu frakciju koja je biološki aktivna. Istodobno stresna stanja stimuliraju simpatički neuronski sustav, što uzrokuje promjenu lučenja slinovne alfa-amilaze iz žlijezda slinovnica. Hipoteza ovoga istraživanja bila je da su studenti sa svakodnevnom intenzivnom fizičkom aktivnošću izloženi kroničnom stresu u odnosu na druge studente koji imaju minimalne fizičke aktivnosti. U istraživanje je bilo uključeno 54 zdravih dobrovoljaca, studenata Sveučilišta u Zagrebu, podijeljenih u dvije skupine; jednu skupinu dobrovoljaca činili su fizički aktivni dobrovoljci (n=27) s Kineziološkog fakulteta, a drugu skupinu činili su fizički neaktivni dobrovoljci (n=27) s ostalih fakulteta. Ispitanici su najprije bili podvrgnuti psihološkom testiranju koje se sastojalo od dva upitnika, Upitnik kvalitete života i Upitnik stilova suočavanja sa stresom te je potom izvršeno uzorkovanje sline. Usporedbom biokemijskih i psiholoških pokazatelja u odnosu na stres zaključeno je da su dvije skupine studenata izjednačene te nije nađeno objektivno uporište po kojem se jednoj skupini mogao pripisati kronični stres. Unatoč bitno različitim fizičkim aktivnostima nije utvrđena razlika između dviju studentskih populacija
Curcumin – a polyphenol with molecular targets in diabetes control?
No full textCurcumin is the principal curcuminoid found in turmeric (Curcuma longa Linn.), whose beneficial effects on glycemic control have been used in ayurvedic and traditional Chinese medicine
Pneumopericardium and colo-pericardial fistula
No full textThis case aims to remind clinicians that uncommon differential diagnoses, such as a colo-pericardial fistula, should be considered in elderly patients displaying clinical signs consistent with an imminent cardiac tamponade, as well as a history of microcytic anemia of unknown etiology, particularly in the emergency setting of an acute pneumopericardium
Changes in pulmonary artery systolic pressure correlate with radiographic severity and peripheral oxygenation in adults with community‐acquired pneumonia
No full textPurpose: The aim of this prospective observational study was to evaluate the relationship between changes in pulmonary artery systolic pressure (ΔPASP) and both severity of community-acquired pneumonia (CAP) and changes in peripheral blood oxygen partial pressure (PaO2).
Materials and Methods: Seventy-five consecutive adult patients hospitalized for treatment of CAP were recruited in this single-center cohort study. Doppler echocardiographic measurement of PASP was performed by 2 staff cardiologists. Follow-up assessment was performed within 2 to 4 weeks of ending antibiotic treatment at radiographic resolution of CAP. Fifteen patients were excluded during follow-up due to confirmation of chronic obstructive pulmonary disease.
Results: Pneumonia was unilateral in 40 (66.7%) and bilateral in 20 (33.3%) patients. Radiographic extent of pneumonia involved 2 pulmonary segments in 31 patients (51.7%), 3 to 5 pulmonary segments in 25 (41.7%), and 6 pulmonary segments in 4 patients (6.6%). ΔPASP between hospital admission and follow-up correlated with the number of pulmonary segments involved (Rho = 0.953; P < .001) and PaO2 (Rho = −0.667; P < .001). The maximum PASP was greater during pneumonia than after resolution (34.82 ± 3.96 vs. 22.67 ± 4.04, P < .001).
Conclusions: Changes in PASP strongly correlated with radiological severity of CAP and PaO2. During pneumonia, PASP appeared increased without significant change in left ventricular filling pressures. This suggests that disease-related changes in lung tissue caused by pneumonia may easily and reproducibly be assessed using conventional noninvasive bedside diagnostics such as echocardiography and arterial blood gas analysis
Portal systemic shunt between the hepatic portal vein and right renal vein in a patient with multifocal hepatocellular carcinoma: Case report
No full textPortal hypertension is a clinical syndrome characterized by the development of collateral circulation and portosystemic shunts, as well as ascites and hepatic encephalopathy. We present the case of a large portosystemic shunt between the hepatic portal vein and aneurysmal right renal vein in a cirrhotic 64‐year‐old man with thrombosis of the portal vein and hepatocellular carcinoma. This is a very rare clinical manifestation which, to our knowledge, has been described only once previously in the literature
Usporedba analgetskog učinka paracetamola primijenjenog intermitentno i putem samostalno kontrolirane crpke nakon lumbalne diskektomije: prospektivna klinička studija
No full textLumbar discectomy is the most common surgical treatment for intervertebral disc extrusion. Postoperative pain is a common clinical problem that greatly affects the length of hospitalization, functional status and patient quality of life. Th e aim of this study was to compare the postoperative analgesic effi cacy of paracetamol administered intermittently and through patient-controlled analgesia (PCA) pump following single level lumbar discectomy. Patients who underwent elective lumbar discectomy of intervertebral disc extrusion at the L4-L5 level diagnosed by magnetic resonance of the lumbosacral spine were included in the study. Pain was assessed at regular intervals for 48 hours through a shortened version of McGill pain questionnaire translated in the Croatian language. When pain was monitored as a summarized variable for each measurement, PCA group significantly stood up after 24 hours with better perception of pain compared to the intermittent group (c2-test, p<0.05). Adequate pain relief is an important aspect of postoperative care in spinal surgery patients. Postoperative use of paracetamol through PCA pump achieved better pain control and pain management versuspostoperative use of intermittent paracetamol analgesia after lumbar discectomy.Lumbalna diskektomija je najčešći kirurški način liječenja hernijacije intervertebralnog diska lumbalnog dijela kralježnice. Bol je čest klinički problem koji uvelike utječe na trajanje bolničkog liječenja, funkcionalni status i kvalitetu života bolesnika. Cilj studije bio je usporediti učinkovitost poslijeoperacijske analgezije paracetamolom primijenjenim intermitentno i putem samostalno kontrolirane crpke (patient-controlled analgesia, PCA) nakon neurokirurškog operativnog zahvata ekstruzije intervertebralnog diska na razini L4-L5. Ispitanici su bili bolesnici kojima je elektivnim zahvatom učinjena lumbalna diskektomija intervertebralnog diska na razini L4-L5, ustanovljena magnetskom rezonancom. Bol je procjenjivana u jednakim vremenskim intervalima kroz 48 sati putem skraćene verzije McGillova upitnika za procjenu boli, na hrvatskom jeziku. Promatrajući bol kao sažetu varijablu svakog mjerenja, skupina ispitanika PCA je pokazala značajno bolje rezultate percepcije boli nakon 24 sata od operacijskog zahvata u odnosu na skupinu koja je primala intermitentno primijenjenu analgeziju paracetamolom (c2-test, p<0,05). Odgovarajuća poslijeoperacijska analgezija važan je aspekt poslijeoperacijske skrbi bolesnika nakon kirurškog zahvata na kralježnici. Poslijeoperacijska primjena paracetamola putem PCA dovodi do bolje kontrole boli u usporedbi s intermitentnim davanjem paracetamola u bolesnika nakon lumbalne diskektomije
Epidemiology, Practice of Ventilation and Outcome for Patients at Increased risk of Postoperative Pulmonary Complications: Las Vegas - an Observational Study in 29 Countries
No full textBACKGROUND Limited information exists about the epidemiology and outcome of surgical patients at increased risk of postoperative pulmonary complications (PPCs), and how intraoperative ventilation was managed in these patients.
OBJECTIVES To determine the incidence of surgical patients at increased risk of PPCs, and to compare the intraoperative ventilation management and postoperative outcomes with patients at low risk of PPCs.
DESIGN This was a prospective international 1-week observational study using the ‘Assess Respiratory Risk in Surgical Patients in Catalonia risk score’ (ARISCAT score) for PPC for risk stratification.
PATIENTS AND SETTING Adult patients requiring intraoperative ventilation during general anaesthesia for surgery in 146 hospitals across 29 countries.
MAIN OUTCOME MEASURES The primary outcome was the incidence of patients at increased risk of PPCs based on the ARISCAT score. Secondary outcomes included intraoperative ventilatory management and clinical outcomes.
RESULTS A total of 9864 patients fulfilled the inclusion criteria. The incidence of patients at increased risk was 28.4%. The most frequently chosen tidal volume (VT) size was 500 ml, or 7 to 9 ml kg1 predicted body weight, slightly lower in patients at increased risk of PPCs. Levels of positive end-expiratory pressure (PEEP) were slightly higher in patients at increased risk of PPCs, with 14.3% receiving more than 5 cmH2O PEEP compared with 7.6% in patients at low risk of PPCs (P < 0.001). Patients with a predicted preoperative increased risk of PPCs developed PPCs more frequently: 19 versus 7%, relative risk (RR) 3.16 (95% confidence interval 2.76 to 3.61), P < 0.001) and had longer hospital stays. The only ventilatory factor associated with the occurrence of PPCs was the peak pressure.
CONCLUSION The incidence of patients with a predicted increased risk of PPCs is high. A large proportion of patients receive high VT and low PEEP levels. PPCs occur frequently in patients at increased risk, with worse clinical outcome
Adenoid cystic carcinoma of the distal trachea: a case report
No full textPrimary malignant tumors of the trachea are very rare with incidence less than two cases in a million per year and only ten percent of these are adenoid cystic carcinomas. Eighty percent of all tracheal tumors are malignant. Diagnosis is usually late because symptoms mimic other conditions like asthma. The clinical presentation may be dramatic when the airway is almost obstructed and emergency recanalization is necessary. Diagnosis is made by chest computed tomography scan or magnetic resonance imaging. Definitive treatment is surgical resection alone or followed by radiation therapy or radiation therapy alone. Radical resection is accomplished only in about half of all cases because of the submucosal growth of the tumor and limited length of tracheal resection. The role of adjuvant radiation therapy in negative resection margin cases is not clear but all patients with positive resection margin benefit from radiation therapy. We present a rare case of a 43-year-old male patient with primary adenoid cystic carcinoma of the distal trachea treated by emergency bronchoscopic recanalization and resection of the tracheal tumor with end-to-end anastomosis