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An infant with neuromotor deviation and Poland syndrome – case report
No full textPolandov sindrom je rijetka kongenitalna anomalija koja se sastoji od ipsilateralne parcijalne ili totalne amastije (nedostatka dojke), atelije (nedostatka mamile), velikog pektoralnog mišića i ipsilateralne simbrahidaktilije. Točna etiologija Polandovog sindroma ostaje nepoznatom, ali se smatra da je odgovoran poremećaj u protoku arterije subklavije u šestom tjednu embrionalnog života. Prikazujemo sedmomjesečno muško dojenče s neuromotornim odstupanjem i aplazijom toraksa koji se očitovao odsutnošću dojke i mamile, te velikog pektoralnog mišića i brahidaktilijom kažiprsta na desnoj strani. Autor nije upoznat s prethodno objavljenim slučajem Polandovog sindroma praćenog neuromotornim odstupanjem. Cilj je ovog prikaza ukazati kako se pravovremenom kineziterapijskom stimulacijom, kojom se potiče mogućnost korištenja neuroplastičnosti te postiže što bolji rezultat u vidu grubih motoričkih vještina i dobre manipulativne spretnosti šake.Poland syndrome is a rare congenital anomaly consisting of ipsilateral partial or total amastia (absence of breast), atelia (absence of mamilla), the large pectoral muscle and ipsilateral symbrachidactylia. The exact etiology of Poland syndrome remains unknown but is thought that a disruption in the flow of subclavian artery might be responsible. It happens to occur during the sixth week of embrionic development. We report a seven-month-old male infant with dystonia and thoracal aplasia, absence of large pectoral muscle, breast and its mamilla and brachydactylia of index finger on the right side. The authors are not familiar with the previously published case of Poland syndrome accompanied with neuromotor deviation. The case therefore suggests that, despite good initial compensation in the early development of fine motor skills, it is necessary to maintain follow-up procedures in order to prevent
later difficulties in the development of motor skills
Discordant sentinel lymph nodes in head and neck melanoma patients
No full textLymphoscintigraphy (LS) in patients (pts) with head and neck melanoma (HNM) provides guidance to surgeons for the neck dissection planning and the SPECT-CT enables precise anatomic localization of sentinel lymph nodes (SLNs)
Čimbenici rizika za mikrovaskularne aterosklerotske promjene u bolesnika sa šećernom bolesti tipa 2
No full textDiabetes mellitus is a metabolic disorder primarily characterized by elevated blood glucose levels and by microvas- cular and macrovascular complications which increase the morbidity and mortality.The aim of this study was to assess whether in high risk patients with type 2 diabetes mellitus whose blood pressure and lipid levels are well controlled still exist risk factors for microvascular changes and target organ damage (nephropathy and retinopathy). In this case con- trol retrospective study 326 patients (111 with nephropathy and/or retinopathy and 215 controls) were enrolled. Nephro- pathy or retinopathy was present in 10.1% and 26.9% cases, respectively. Only 71% of patients (no significant difference between cases and controls) were treated with antidiabetic drugs. Therefore their diabetes was not properly controlled (hemoglobin A1c was 7.96% in cases and 7.58% in controls). Patients with microvascular changes had significantly lon- ger diabetes than the controls (p < 0.05) but there were no significant differences between these two groups concerning lipids concentrations. Statins and fibrates were used by significantly less (p < 0.05) patients with microvascular compli- cations than by those without them (21.6% vs. 36.3% and 1.8% vs. 17.2% respectively). The results of this study suggest that the duration of the disease and adequate control of glycaemia in patients with type 2 diabetes mellitus are more im- portant for microvascular complications than the serum lipoproteins levels. Lipid-lowering treatment might have an im- pact on microvascular complications in patients with type 2 diabetes, irrespectively of their serum lipid levels.Šećerna bolest obilježena je povišenim razinama glukoze u krvi te razvitkom mikrovaskularnih i makrovaskularnih komplikacija koje su uzrok povećanom morbiditetu i mortalitetu. Cilj je ovog istraživanja bio istražiti da li u visoko rizičnih bolesnika sa tipom 2 šećerne bolesti i dobro kontroliranim arterijskim tlakom i lipidima u serumu postoje rizični čimbenici koji mogu biti uzrokom mikrovaskularnih promjena i posljedičnog oštećenja ciljnih organa, posebno nefropatije i retinopatije. U ovo “case-control” retrospektivno ispitivanje uključili smo sveukupno 326 ispitanika (111 sa nefropatilom i/ili retinopatijom i 215 bolesnika bez tih komplikacija – kontrolna skupina). 10,1% ispitanika imalo je nefropatiju, a 26.9% imalo je retinopatiju. Samo 71% ispitanika (bez značajne razlike među skupinama) bilo je liječeno antidijabeticima. Stoga ne čudi da im je regulacija glukoze u krvi bila nedostatna (hemoglobin A1c bio je 7.96% u bolesnika sa nefro/retinopatijom, a 7.58% u onih kontrolne skupine). Bolesnici s mikrovaskularnim komplikacijama u usporedbi s onima iz kontrolne skupine rjeđe su koristili statine (21.6% vs. 36.3%) i fibrate (1.8% vs. 17.2%). Bolesnici sa mikrovaskularnim promjenama bolovali su od dijabetesa značajno dulje nego oni iz kontrolne skupine (p < 0.05) ali nije bilo razlike u koncentracijama lipida izme|u te dvije skupine. Rezultati našeg istraživanja ukazuju da su u bolesnika sa tipom 2 šećerne bolesti za razvitak mikrovaskularnih komplikacija važniji trajanje bolesti i odgovarajuća kontrola glikemije nego li koncentracije lipoproteina u serumu. Primjena lijekova za snižavanje lipida u krvi može imati učinak na mikrovaskularne komplikacije u bolesnika sa šećernom bolešću tipa 2 neovisno o koncentracijama lipida u serumu
Fetal intrapartum care
No full textBrojna su istraživanja koja analiziraju razne tehnike probira i praćenja fetusa tijekom trudnoće i porođaja s ciljem da se poboljša perinatalni ishod — smanji mortalitet i morbiditet fetusa. lako rezultati nekih radova ohrabruju, velik broj njih ostavlja dvojbe o učinkovitosti pojedinih metoda, tako da će se morati nastaviti s dokazivanjem povoljnog utjecaja pojedinih postupaka na ishode visokorizičnih trudnoća u velikim randomiziranim kontroliranim istraživanjima prije uvođenja u postupnike. Problem većine testova za detekciju fetalnog distresa ili metoda intrapartalnog praćenja je dobra osjetljivost, ali velik udio lažno pozitivnih nalaza koji otežavaju donošenje pravovremene odluke o dovršenju trudnoće i mogu povećati broj nepotrebnih intervencija. U visokorazvijenim zemljama kao što je SAD, medicinska opažanja zasnovana na dokazima sugeriraju široko korištenje kardiotokografije i carskog reza za otkrivanje i sprječavanje posljedica fetalnog distresa., dok nerazvijene i zemlje u razvoju ulazu napore da dostupnost antenatalne i intrapartalne zaštite bude što šira, ovisno o sredstvima i raspoloživom osoblju.There are numerous research gaps and large, adequately controlled trials are still needed for most of the interventions we considered. The impact of monitoring interventions on stillbirth relies on use of effective and timely intervention should problems be detected. Numerous studies indicated that positive tests were associated with increased perinatal mortality, but while some tests had good sensitivity in detecting distress, false-positive rates were high for most tests, and questions remain about optimal timing, frequency, and implications of testing. Few studies included assessments of impact of subsequent intervention needed before recommending particular monitoring strategies as a means to decrease stillbirth incidence. In high-income countries such as the US, observational evidence suggests that widespread use of cardiotocography with Caesarean section for fetal distress has led to significant declines in stillbirth rates. Efforts to increase availability of Caesarean section in low-/middle-income countries should be coupled with intrapartum monitoring technologies where resources and provider skills permit
Mast cell leukemia - case report
No full textMastocitna leukemija je iznimno rijetka, češće nastaje de novo, a oko 15% ih se razvija iz ostalih oblika mastocitoza. Definira se kao visoko-maligna leukemija s lošom prognozom i kratkim preživljenjem. Prikazujemo 72-godišnju bolesnicu, koja je zaprimljena u bolnicu zbog kliničke sumnje na plazmocitom. Pri pregledu nađene su ekcematozne promjene na koži trupa i podlaktica, te slabija pokretljivost. Radiološke slike kostiju pokazale su osteolitičke lezije zdjelice i desne natkoljenice. Punkcijom koštane srži dobivena je hipercelularna koštana srž u kojoj 80% stanica čine mastociti i atipične nezrele mastocitne stanice koje su pozitivne na toluidin, kloracetat, alcian-blu, kiselu fosfatazu i Sudan black, a PAS (Periodic acid schiff) i POX (peroksidaza) su negativni. U razmazu periferne krvi također su nađeni pojedinačni mastociti. Na osnovi morfologije stanica i citokemijskih reakcija postavljena je citološka dijagnoza mastocitne leukemije. Učinjena je i biopsija kosti koja potvrđuje citološku dijagnozu. Bolesnica je liječena antihistaminicima i analgeticima. Dva mjeseca nakon postavljene dijagnoze došlo je do prijeloma prethodno bolne desne natkoljenice nakon čega je provedena lokalna radioterapija. Bolesnica je umrla unutar 6 mjeseci od postavljanja dijagnoze. Zaključujemo da, iako iznimno rijetka, mastocitna leukemija se citološki može dijagnosticirati kada se u koštanoj srži nađe više od 20% patoloških oblika mastocita uz njihovu pojavu u perifernoj krvi.Mast cell leukemia is extremely rare, more offen arises de novo and in 15% of cases developes from preexistence mast cell diseases. It is a high malignant leukemia with bad prognosis and a short survival. A 72-year old female was admitted to hospital with clinically suspected plasmocytoma. She had eccematoid changes on her trunk and underarms. Radiogramm showed osteolytic lesions of the right thigh and pelvis. FNA of the bone marrow revealed hypercellular smear with 80% of mast cells and immature mast cells which were cytochemically positive to toluidin (Figure 1. and 2.), chloracetate, alcian blue, acid fosphatase and Sudan black and negative to periodic acid Schiff (PAS) and peroxidase (POX). The peripheral blood smear showed single mast cells which were positive to toluidin. The bone marrow biopsy confirmed mast cell leukemia. The chariogramm of the bone marrow showed numerical and structural chromosomal changes. Two month after the diagnosis the patient suffered from right thigh fracture and was treated with local radiotherapy, antihistaminic and analgetic therapy. The patient died within 6 month after the diagnosis. Conclusion: Mast cell leukemia is very rare and high grade leukemia with short survival time. Cytological diagnosis is possible, when there is more then 20% of atypical mast cells in the bone marrow aspirate. The diagnosis of aleukemic variant of mast cell leukemia could be stated if there is less then 10% of mast cells in the peripheral blood
Osteosinteza kutno-stabilnom pločicom trodjelnih i četverodjelnih prijeloma proksimalnog humerusa u starijih bolesnika: komplikacije i funkcionalni rezultat
No full textDespite recent advances in operative techniques, internal fixation of (3- and 4-part) displaced proximal humeral fractures in elderly patients with osteoporotic bone remains controversial, sometimes followed by poor results. The aim of the present study was to evaluate outcomes of internal fixation with locking plate of multi-fragment proximal humeral fractures in elderly patients. The study cohort comprised 59 consecutive patients (mean age 70.1) with 3- and 4-part fractures who had undergone open reduction and internal fixation with locked plate at Sestre milosrdnice University Hospital Center in Zagreb, Croatia. All patients were invited for follow-up examinations and underwent standard x-ray examination preoperatively to assess fracture pattern in the operating theatre as well as at 6 weeks, 3 and 6 months, 1 year, and then annually after surgery to assess fracture healing or complications. Clinical outcomes were measured by constant score. Patients were followed-up for 14 to 36 months. The overall complication rate was 27.1%. The mean constant score at 1-year follow-up was 70.2 points for 3-part fractures vs. 64.2 for 4-part fractures(p<0.0001). In conclusion, despite a relatively high overall complication rate, internal fixation with locking plate provided moderate to good functional results in the treatment of osteoporotic complex proximal humeral fractures.Unatoč novijim dostignućima operacijske tehnike unutarnja fiksacija (trodjelnih i četverodjelnih) dislociranih prijeloma proksimalnog humerusa kod starijih bolesnika s osteoporotičnom kosti i dalje je kontroverzna, ponekad praćena lošim rezultatima. Cilj ove studije bio je procijeniti rezultat unutarnje fiksacije kutno-stabilnom pločicom multifragmentarnih prijeloma proksimalnog humerusa kod starijih bolesnika. Studija je obuhvatila 59 bolesnika (srednja dob 70,1) s trodjelnim i četverodjelnim prijelomom, kod kojih je učinjena otvorena repozicija i untarnja fiksacija kutno-stabilnom pločicom u KBC „Sestre milosrdnice“, Zagreb, Hrvatska. Svi bolesnici praćeni su poslijeoperacijski kroz redovne kontrolne preglede. Standardna radiološka obrada provedena je prijeoperacijski kako bi se ocijenio tip prijeloma, zatim 6 tjedana, 3 i 6 mjeseci te 1 godinu nakon kirurškog zahvata, a potom jedanput na godinu kako bi se ocijenilo zaraštanje prijeloma i komplikacije. Za mjerenje kliničkog rezultata korišten je funkcionalni zbir. Bolesnici su praćeni od 14 do 36 mjeseci. Ukupna učestalost komplikacija bila je 27,1%. Srednji funkcionalni zbir nakon prve godine praćenja bio je 70,2 za trodjelne prijelome i 64,2 za četverodjelne prijelome (p<0,0001). Zaključno, unatoč relativno visokom postotku komplikacija unutarnja fiksacija kutno-stabilnom pločicom pružila je srednji do dobar funkcionalni rezultat u liječenju složenih osteoporotičnih prijeloma proksimalnog humerusa
The psychological effects of prenatal diagnostic procedures: maternal anxiety before and after invasive and noninvasive procedures
No full textObjectives:(1) To examine the change in anxiety before and after prenatal diagnostic procedures in women undergoing invasive (amniocentesis) and noninvasive (ultrasound) procedures ; and (2) to examine predictors of anxiety before the diagnostic procedure. A short-term follow-up study was conducted on a sample of pregnant women in the second trimester. Questionnaires were administered to women scheduled for amniocentesis (n = 37) and ultrasonography (n = 37) before and immediately after the procedure. The following questionnaires were administered: the State-Trait Anxiety Inventory, the Affect Intensity Measure, the COPE inventory, and the Optimism–Pessimism Scale. Prior to the administration of the prenatal diagnostic procedure, measured anxiety levels were the same in both groups of women (p > 0.05). An interaction effect of a two-way ANOVA revealed that anxiety decreased after the procedure in the ultrasound but not the amniocentesis group (F(1, 72) = 5.01, p = 0.028). Although coping styles and affect intensity were found to be related to anxiety (p < 0.05), they were not significant predictors of anxiety before the diagnostic procedure when controlling for trait anxiety and procedure type. Anxiety levels associated with noninvasive but not after invasive, prenatal diagnostics tests decrease immediately following the procedure
Natural history of cervical squamous intraepithelial lesions
No full textLaboratory and epidemiologic data suggest that persistent infections with carcinogenic human papillomaviruses (HPV) cause virtually all cervical cancers (CC). There are over 100 HPV types, of which more than 30 infect the genital area of women. Genital HPV infection results in a variety of outcomes. lmmune response appearsto be a key determinant of HPV epidemiology and oncogenicity. Studies of the natural history of CC indicate that infection with H PV may be transient (approximately 9O% of HPV infections clear within two years) or can persist and cause cervical intraepithelial lesions (ClN) of a different degree. Few CIN have the potential to progress to invasive cancer
Pristup na distalni femur osteotomijom distalnog pola patele i unutarnja fiksacija košarastom pločicom kod složenih zglobnih prijeloma: prikaz pet slučajeva
No full textAccording to AO classification, 33-C3 (complete articular multifragmentary) fracture of distal femur is characterized by complex articular involvement, along with short distal femoral block with multiple small fragments and usually with severe soft tissue abruption. In such cases of complex articular fracture of distal femur with extensive comminution of the femur condyle that is often seen in these fractures, anatomical reduction is quite difficult. Minimal fixation strategies sometimes do not provide an optimal degree of reduction and stability of the distal femoral block osteosynthesis. We describe 5 cases of treatment of the 33-C3 distal femoral fractures using arthrotomy of the knee joint by osteotomy of the distal pole of the patella and internal fixation with basket plate as an alternative approach for anatomical reduction of the comminuted articular surface.Prema AO klasifikaciji, 33-C3 (zglobni multifragmentarni) prijelomi distalnog femura obilježeni su složenim zahvaćanjem zgloba, zajedno s kratkim distalnim fragmentom femura, višestrukim malim fragmentima i često s teškim nagnječenjem mekog tkiva. U takvim slučajevima složenog zglobnog prijeloma distalnog femura s teškom kominucijom femoralnih kondila koja se često susreće kod ovih prijeloma, anatomska redukcija dosta je otežana. Strategije minimalne fiksacije često ne pružaju dovoljan stupanj redukcije i stabilnosti osteosinteze distalnog femoralnog fragmenta. Ovdje opisujemo 5 slučajeva liječenja 33-C3 distalnog prijeloma femura koristeći artrotomiju koljenskog zgloba osteotomijom distalnog pola patele i unutarnju fiksaciju košarastom pločicom kao alternativni pristup za anatomsku redukciju kominutivne zglobne površine
Pregnant Women’s Knowledge and Attitudes to Prenatal Screening for Fetal Chromosomal Abnormalities: Croatian Multicentric Survey
No full textWe aimed to assess opinion and preferences of Croatian pregnant women regarding the prenatal screening tests for trisomies. The study was conducted in Zagreb, Split, Čakovec, Nova Gradiška, Gospić and Zlatar. It was organized in the public primary healthcare centers, among the pregnant volunteers during their first visit to an antenatal clinic (7–12 weeks pregnant). The respondents filled anonymous questionnaire reflecting their knowledge and attitudes to the screening options. In total, 437 completed questionnaires were selected. The average maternal age and the level of education differed significantly between the respondents in the respective cities (P<0.001). Of the respondents with positive attitude towards screening, the majority would prefer the first-trimester combined test (160/219; 73.1%), while 37/219 (16.9%) opted for the second-trimester biochemical screening. The remaining 22/219 (10.0%) would accept only the ultrasound screening. Among the 224 respondents, who would accept the combined first-trimester test, 95 (42.4%) held a college and university degree, whereas among 59 women, who would choose the second-trimester biochemical screening, 14 were highly educated (23.7%). The difference was statistically significant (P=0.016). The univariate regression analysis showed that age, level of education and previous information were significant variables predictive for the choice of the test; the level of education and previous knowledge remained significant in the multivariate model. The survey has revealed some of the points that should be improved in the future concept of screening program in Croatia. Health professionals should persist to mend women’s knowledge about prenatal screening, taking into consideration women’s preferences as well