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Combined ultrasound and biochemical screening for fetal aneuploidy at 10 – 14 weeks of pregnancy: first results of test performance in Croatia
No full textCilj rada: Retrospektivna studija nakon primjene kombiniranog ultrazvučno-biokemijskog testa probira trisomija u prvom tromjesečju trudnoće. Metode: Od veljače 2006. do srpnja 2008. godine probir je učinjen u 1112 trudnica između 10. i 14. tjedna trudnoće. Individualni rizik trisomije 21, 18 i 13 izračunavali smo kombinacijom dobnog rizika trudnice, ultrazvučnih biljega u ploda (debljina nuhalnog nabora – NT, udaljenosti tjeme-trtica – CRL) te biokemijskih biljega u serumu trudnice (slobodni β-hCG i PAPP-A), pomoću licenciranog računalnog programa (Typolog). Koncentracije biokemijskih biljega smo određivali imunometrijskom kemiluminiscentnom metodom (IMMULITE). Biokemijske biljege, kao i NT u odnosu na CRL, izrazili smo u obliku višekratnika MoM, u odnosu na dnevne regresijske medijane za odgovarajuću gestaciju u neugroženim trudnoćama. Rezultate smo obradili nakon dovršenih svih ispitanih trudnoća. Ukupno su 62 testirane trudnice imale povećani kombinirani rizik trisomije 21, od kojih je 10 trudnica imalo i povećani rizik trisomije 18/13. Četiri trisomije 21 i jedna trisomija 18 otkrivene su prenatalnom dijagnozom; stopa detekcije bila je 100% (5/5). U trudnica s povećanim rizikom u probiru učinjeno je 7 biopsija koriona i 38 ranih amniocenteza. Udio lažno-pozitivnih rezultata bio je 5.1%. Zaključak: Prvi rezultati provođenja kombiniranog probirnog testa u Hrvatskoj potvrdili su visoku osjetljivost i veću specifičnost, u poredbi s biokemijskim probirnim testom u drugom tromjesečju trudnoće.Objective: Retrospective study of the results of the first-trimester combined screening for fetal trisomies with ultrasound and biochemical markers. Methods: In the period from February 2006 to July 2008, a total of 1112 pregnant-women underwent screening between the 10th and 14th gestational week. Individual risk for trisomies 21, 18 and 13, combining maternal age, ultrasonography (nuchal translucency, crown-rump length) and serum biochemical analytes (free β-hCG, PAPP-A) was computed by means of licensed Typolog software. Concentrations of biochemical markers were determined by chemiluminiscent immunometric assay (IMMULITE). Both biochemical markers, as well as NT, were expressed as Multiples of the Median (MoM), based on the regressed medians of the corresponding gestational age in unaffected pregnancies. ResultsŽ: All studied pregnancies were followed up to term. A total of 62 pregnant women were categorized as high-risk for trisomy 21, and 10 of them had also an elevated risk for trisomies 18/13, respectively. Four trisomies 21 and one trisomy 18 were detected through combined test and confirmed with prenatal diagnostic procedure. Detection rate was 100%. In those with high risk, 7 chorionic villi sampling and 38 amniocenteses were performed. False-positive rate was 5.1%. Conclusion: The results of the first-trimester screening in Croatia confirmed high sensitivity and better specificity of the combined ultrasonic and biochemical markers, in relation with the second-trimester biochemical screening test
Plastično-rekonstrukcijska i estetska kirurgija: Reumatoidni artritis šake
No full textReumatoidni artritis je kronična sistemska, autoimuna bolest nepoznate etiologije koja se očituje simetričnim upalnim poliartritisom, izvanzglobnim simptomima (pluća, bubreg i dr.), te postupnim razaranjem zglobova. Posljedice su teške deformacije i invalidnost. U svijetu se prevalencija procjenjuje na 1 do 2% odraslih, a kod populacije starije od 65 godina i više od 10%. Reumatoidni artritis je 2,5 puta češći u žena nego u muškaraca. Reumatoidni faktor pozitivan je kod velike većine bolesnika
Plastično-rekonstrukcijska i estetska kirurgija: Tumori šake
No full textTumori šake mogu nastati od bilo kojega tkiva šake: kože, mekih tkiva, krvnih žila, živaca, kosti, hrskvica i drugih. Najčešće je riječ o dobroćudnim tumorima. Dijagnoza tumora šake postavlja se na osnovu pregleda, rendgenske snimke šake, a ustreba li mogu se učinti i specifične pretrage (kompjutorizirana tomografija, magnetska rezonancija ili angiografija)
Maligni limfomi štitnjače
No full textPrimary thyroid lymphoma is a rare disease that accounts for about 5% of all thyroid neoplasms. It shows a female predominance, especially in women with a pre-existing Hashimoto.s disease. During a 15-year period, 11 patients were diagnosed with primary thyroid lymphoma at Department of Endocrinology, Diabetes and Metabolic Diseases, Sestre milosrdnice University Hospital. There were no records on associated Hashimoto.s thyroiditis in any of them, which is inconsistent with the international literature reporting on such association in 40%-80% of cases. Painless neck edema was the most common physical symptom for patient presentation. The diagnosis was based on fine needle aspiration cytology, while the spread of disease to other organ systems was ruled out by other studies (computed tomography, ultrasonography and gallium scintigraphy). However, it should be noted that diffuse or nodular lymphoma cannot always be classified only by aspiration cytology. The World Health Organization classification was used. Today, it has been generally accepted that thyroid lymphomas belong to a group of lymphomas associated with mucosa-associated lymphoid tissue (MALT). The most common form of nonHodgkin's lymphoma (NHL) of the thyroid was B-cell phenotype lymphoma with a high malignancy grade. All patients were treated with chemotherapy according to the CHOP protocol (cyclophosphamide, doxorubicin, vincristine, prednisone). Eight patients underwent surgical treatment, three of them for compressive syndrome, followed by radiotherapy. The follow-up of patients with primary thyroid lymphoma revealed high disease aggressiveness and short survival, while complete remission was only occasionally recorded.Primarni limfomi štitnjače su rijetka bolest, a pojavljuju se u oko 5% slučajeva svih neoplazma štitnjače. Češće se javljaju kod žena, osobito onih s prethodno postojećom Hashimotovom bolešću. U Zavodu za hematologiju Kliničke bolnice "Sestre milosrdnice" u 15-godišnjem razdoblju dijagnosticirano je 11 bolesnika s primarnim limfomom štitnjače. Ni za jednog bolesnika, međutim, nije se znalo da boluje od pridruženog Hashimotovog tiroiditisa, što se ne uklapa u podatke iz svjetske znanstvene literature koji govore o 40%-80%. Najčešći simptom koji je doveo bolesnika na pregled liječniku bila je bezbolna oteklina vrata. Dijagnoza je postavljena putem aspiracijske citopunkcije, a ostalim pretragama (CT, UZV, scintigrafija tijela radiogalijem) isključena je proširenost bolesti u druge organske sustave (staging). Treba, međutim, napomenuti kako isključivo citopunkcijom nije uvijek moguće klasificirati difuzni i nodularni limfom. Klasifikacija je provedena prema Svjetskoj zdravstvenoj organizaciji. Danas je općenito prihvaćeno mišljenje da limfomi štitnjače pripadaju skupini limfoma pridruženih mukoznom limfatičnom tkivu (MALT, mucosa associated lymphoid tissue). Najčešći oblik ne-Hodgkinovog limfoma (NHL) štitnjače bio je B stanični fenotip visokog stupnja malignosti. Svi bolesnici su liječeni kemoterapijom po shemi CHOP (ciklofosfamid, doksorubicin, vinkristin, prednizon), a kod 8 bolesnika je primijenjen kirurški zahvat, od toga kod troje zbog kompresivnog sindroma, a potom je provedena radioterapija. Praćenjem bolesnika s primarnim limfomom štitnjače uočena je velika agresivnost bolesti i kratko preživljavanje, ali su rjeđe moguće i potpune remisije
Plastično-rekonstrukcijska i estetska kirurgija: Infekcije na šaci
No full textInfekcije u području šake obuhvaćaju površinske infekcije kože i potkožja, infekcije u području nokta, infekcije u području tetive i tetivne ovojnice, infekcije dubokih prostora šake, septički artritis i osteomijelitis
Recombinant factor Vlla therapy in a patient on long term anticoagulant treatment with a bleeding and acute subdural hematoma
No full textIn this paper we report on the successful correction of a coagulopathy with activated recombinant factor seven (rFVIIa) therapy which enabled surgical removal of a life threatening subdural hematoma. The severe coagulopathy developed due to long term warfarin therapy, which followed heart valvular reconstruction and replacement. The coagulopathy failed to improve following fresh frozen plasma and vitamin K therapy. Activated recombinant factor VII therapy became the treatment of choice, which enabled the life saving surgical removal of the subdural hematoma
Koroidna neovaskularizacija kod makularne degeneracije povezane s dobi liječene fotodinamskom terapijom i intravitrealnim triamcinolon acetonidom
No full textThe aim of the study was to show the effect of combined photodynamic therapy and intravitreal injection of triamcinolone acetonide in the treatment of choroidal neovascularization due to age-related macular degeneration. This retrospective, nonrandomized study included 20 patients with predominantly classic choroidal neovascularization due to age-related macular degeneration with no prior treatment. At baseline, all patients underwent ophthalmologic examination. Fluorescein angiography and optical coherent tomography were performed and analyzed. Triamcinolone acetonide, 4 mg, was intravitreally applied at 24-48 hours after standard photodynamic therapy. Follow up was scheduled at 3, 6 and 9 months. After 9 months, visual acuity improved in four, remained unchanged in 14 and decreased in two patients. In all patients, complete closure of choroidal neovascularization occurred after 9 months. At that time, a decrease in the central foveal thickness was also recorded in all patients. Combined photodynamic therapy and intravitreal injection of triamcinolone acetonide is a safe method in the treatment of choroidal neovascularization due to age-related macular degeneration, and leads to complete closure of choroidal neovascularization. To prove these promising results, a carefully designed, randomized, controlled study in a larger group of patients is needed.Prikazuju se rezultati kombinirane intravitrealne primjene triamcinolona i fotodinamske terapije kod razvoja koroidnih neovaskularizacija koje su nastale kao posljedica senilne makularne degeneracije. U retrospektivnu nerandomiziranu studiju bilo je uključeno 20 bolesnika s pretežito klasičnom koroidnom neovaskularizacijom, koji do tada nisu bili liječeni. Kod svih bolesnika učinjen je standardni oftalmološki pregled, fluoresceinska angiografija i optička koherentna tomografija. Triamcinolon acetonid, 4 mg, apliciran je intravitrealno 24-48 sati nakon fotodinamske terapije. Praćenje bolesnika je provedeno nakon 3, 6 i 9 mjeseci. Nakon 9 mjeseci kod 4 bolesnika došlo je do poboljšanja vidne oštrine, kod 14 bolesnika vidna oštrina je ostala stabilna, dok je kod 2 bolesnika zabilježen pad vidne oštrine. Potpun nestanak koroidne neovaskularizacije kod svih je bolesnika zabilježen nakon 9 mjeseci. Kombinirana primjena triamcinolona i fotodinamske terapije sigurna je metoda u liječenju pretežito klasičnih koroidnih neovaskularizacija, koja dovodi do njihovog potpunog zatvaranja i nestajanja, no za potvrdu ovih rezultata potrebna je randomizirana analiza na većem broju bolesnika
Infekcija, upala i antibiotici
No full textPatološki mikroorganizmi mogu na čovjeku izazvati sljedeće posljedice: privremenu kolonizaciju, trajnu kolonizaciju, izazvati bolest (infekciju) organizma. Pojam infekcije često se koristi za objedinjavanje pojmova kolonizacije i bolesti što nije opravdano. Postoje tri osnovne obrane od invazije mikroorganizama: prirodna obrana (koža, sluznica, želučana kiselina, žuč itd.), nespecifična imunološka reakcija prirodnih antigena (temperatura, neutrofili, makrofagi, interferon, prirodne stanice ubojice), specifična antigenska obrana koja ciljano djeluje na uzročnika (antitijela, T-stanice). Kirurškim infekcijama nazivamo one koje treba kirurški liječiti ili one koje su nastale kao posljedica kirurškoga postupka. Razvoj infekcije ovisi o tri čimbenika: količini unesenih mikroorganizama, virulenciji uzročnika, općem stanju organizma (imuni sustay, dob, prokrvljenost tkiva, kirurški postupak za operirane bolesnike itd.)
Dental procedures in patients receiving oral anticoagulant therapy
No full textThere is a widespread belief among physicians and dentists that oral anticoagulant therapy must be discontinued before and for some time after dental procedures. This practice may increase the risk of potentially life-threatening thromboembolism. The present literature does not support routine discontinuation of anticoagulant therapy for dental patients. There is a theoretical risk of bleeding after dental surgery in patients at therapeutic levels of anticoagulation, however, it is minimal and may be greatly outweighed by the risk of thromboembolism upon anticoagulant therapy withdrawal. Thus, dental extractions can be performed without modification of oral anticoagulant therapy. In most patients local hemostasis with gelatin sponge, fibrin glue, sutures and/or mouthwash with tranexamic acid or eaminocaproic acid is sufficient to prevent postoperative bleeding
Stečeni inhibitor faktora V: prikaz slučaja
No full textA 19-year-old asymptomatic man who was admitted to our hospital for investigation of prolonged screening coagulation assays, prothrombin time and activated partial thromboplastin time is presented. Further evaluation revealed factor V deficiency and the presence of specific factor V inhibitors. The appearance of these inhibitors may be associated with administration of some antibiotics, topical bovine thrombin preparations containing bovine factor V during surgical or dental procedures, after blood transfusions and in patients with malignancy or autoimmune diseases. Factor V inhibitors may also develop spontaneously in patients without any clearly identifiable cause. Our patient had no personal or family history of bleeding tendency or thromboembolic event. There is a general consensus that asymptomatic patients should not be treated regardless of their inhibitor titer and residual factor V levels.Prikazan je slučaj 19-godišnjeg bolesnika bez simptoma, koji je upućen u našu bolnicu zbog ispitivanja uzroka produljenih probnih testova zgrušavanja, protrombinskog vremena i aktiviranog parcijalnog tromboplastinskog vremena. Daljnje istraživanje ukazalo je na nedostatak faktora V i prisutnost specifičnog inhibitora faktora V. Prisutnost ovih inhibitora može biti povezana s primjenom antibiotika, goveđeg trombina koji sadrži goveđi faktor V primijenjenih lokalno za vrijeme kirurških i zubnih zahvata, nakon transfuzije krvi i u bolesnika s malignim ili autoimunim bolestima. Inhibitori faktora V mogu također nastati spontano u bolesnika bez jasno otkrivenog uzroka. Naš bolesnik i njegova obitelj nisu imali anamnestičkih podataka o sklonosti krvarenju niti tromboemboliji. Opći je stav da bolesnike bez simptoma nije potrebno liječiti, bez obzira na titar inhibitora i preostalu razinu faktora V