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Liječenje venske tromboembolije za vrijeme trudnoće i babinja
No full textVenous thromboembolism (VTE) occurs infrequently but remains the leading cause of pregnancy- and puerperium-related mortality in industrialized countries. In pregnant women, the risk of VTE is about 4- to 5-fold that in non-pregnant women. The pathogenesis of VTE is associated with venous stasis, endothelial damage to pelvic veins at delivery, and procoagulant changes that occur during pregnancy and puerperium. The most common risk factors for VTE during pregnancy and puerperium are previous thrombotic event(s), thrombophilia, age over 35, obesity and operative delivery. Deep venous thrombosis in pregnancy and puerperium is usually left-sided (85% versus 55% in non-pregnant patients) and iliofemoral (72% in pregnancy versus 9% in non-pregnant patients). Low-molecular weight heparins (LMWHs) are the drugs of choice for the treatment of VTE during pregnancy and puerperium, as they are effective and have substantially fewer side effects such as heparin-induced thrombocytopenia, bleeding and osteoporosis as well as more reliable antithrombotic activity compared with unfractionated heparin.Venska tromboembolija (VTE) nije učestala, ali ostaje vodećim uzrokom smrtnosti za vrijeme trudnoće i babinja u razvijenim zemljama. Rizik VTE je oko 4-5 puta veći u trudnica nego u žena iste dobi bez trudnoće. Nastanak VTE je povezan s venskom stazom, oštećenjem endotela vena zdjelice uslijed poroda, te povećanom sklonošću zgrušavanju krvi za vrijeme trudnoće i babinja. Najčešći rizični čimbenici VTE za vrijeme trudnoće i babinja su prethodna tromboza(e), nasljedna sklonost trombozi, trudnice starije od 35 godina, debljina i porod operacijskim zahvatom. Duboka venska tromboza za vrijeme trudnoće i babinja je češće lijevostrana (85% nasuprot 55% u žena iste dobi koje nisu trudne) i iliofemoralna (72% u trudnica nasuprot 9%). Heparini male molekularne težine su lijekovi izbora u liječenju VTE za vrijeme trudnoće i babinja, jer su djelotvorni i imaju znatno manje nuspojava, kao trombocitopeniju potaknutu heparinom, krvarenje i osteoporozu te pouzdaniju protutrombotsku aktivnost u odnosu na nefrakcionirani heparin
Neurofibromatosis Type 1 in Pregnancy
No full textThe report presents two cases of neurofibromatosis type 1 one previously known and one detected during pregnancy. It describes how the disease was detected and diagnosed, and what was the outcome of pregnancies. This is the first case of prenatal neurofibromatosis type 1 diagnosed in our clinic
Analiza kvalitativnih svojstava dermatoglifa digitopalmarnog kompleksa u bolesnika s primarnim glaukomom otvorenog kuta
No full textThe primary open-angle glaucomas are a group of diseases that have in common characteristic morphological changes at the optic nerve head and retinal nerve fiber layer, progressive retinal ganglion cells death and characteristic visual field loss. The risk for primary open angle glaucoma rises continuously with the level of the intraocular pressure. The disease advances slowly and there are no symptoms. Primary open angle glaucoma is caused by abnormal aqueous humour outflow in the trabecular meshwork in the open angle. Etiopathogenesis of primary open angle glaucoma is unclear. The increased risk of glaucoma in relatives has long been recognized. Frequency for manifestation of the disease is 10–30% in family members. The discovery of the specific gene loci responsible for the manifestation of glaucoma has helped us to understand its mechanism of origin and definitely confirmed the hereditary nature of this disease. Digito- -palmar dermatoglyphs were already used to determine hereditary base of many diseases and it was the reason for investigation of their qualitative patterns in patients with glaucoma (22 males and 23 females), their immediate relatives (19 males and 23 females) in comparison to a group of phenotypically healthy population (52 males and 56 females). The results pointed a connection with the dermatoglyphic traits of the digito-palmar complex between patients with glaucoma and their immediate relatives. There is a possible discrimination of patients and their immediate relatives from phenotypically healthy population, too.Primarni glaukom otvorenog kuta predstavlja grupu bolesti kojima su zajedničke karakteristične morfološke promjene na glavi vidnog živca i retinalnom sloju nervnih niti, progresivna smrt ganglijskih stanica i karakteristična oštećenja vidnog polja. Rizik pojave bolesti raste kontinuirano s visinom intraokularnog tlaka, a tijek je postepen i asimptomatski. Bolest je uzrokovana poremećajem odvoda sobne vodice u trabekularnom sustavu komoričnog kuta koji je otvoren. Etiopatogeneza primarnog glaukoma otvorenog kuta nije dovoljno jasna. Povećan rizik od pojave glaukoma kod bližih srodnika već dugo je poznat. Među srodnicima učestalost pojave glaukoma se kreće od 10–30%. Otkrića specifičnih genskih lokusa odgovornima za pojavu glaukoma doprinose razumijevanju mehanizma nastanka i svakako potvrđuje obiteljsko pojavljivanje ove bolesti. Digitopalmarni dermatoglifi su primjenjivani u procjeni nasljedne osnove mnogih bolesti, što je bio povod za ispitivanje kvalitativnih i kvantitativnih svojstava dermatoglifa digito-palmarnog kompleksa kod oboljelih od glaukoma (22 muškarca i 22 žene), bližih srodnika oboljelih (19 muškaraca i 23 žene) u odnosu na fenotipski zdravu populaciju (52 muškarca i 56 žena). Iz dobivenih rezultata utvrdila se povezanost svojstava dermatoglifa digito-palmarnog kompleksa kod glaukomskih bolesnika sa svojstvima dermatoglifa kod bližih neoboljelih srodnika. Također se utvrdila razlika po kojoj se oboljeli i njihovi bliži srodnici mogu diskriminirati od fenotipski zdrave populacije
Poremećaj rasta djece s tipom 1 šećerne bolesti
No full textThe aim of the research was to analyze anthropometric variables in children with type 1 diabetes mellitus (DM) in relation with the stage of pubertal development at onset of disease and quality of metabolic control over five-year long observation. Diagnosed children were taller than their peers. This especially referred to age group between 4 and 9.5 years. On the whole, weight of the patients and healthy controls did not differ. However, the diagnosed children had substantially lower weight in puberty than healthy controls. Body mass index was significantly lower in the group of diagnosed children on the whole and in puberty. During a five-year long observation patients have had a significant retardation of growth. However, that retardation referred primarily to patients in prepuberty. Growth retardation was more pronounced with bad metabolic control. Growth was satisfactory if onset of disease had been in puberty. A significant weight gain was observed in patients in puberty whereas in those in prepuberty there was no significant change of body weight at the end of five-year long observation. Metabolic control did not affect observed changes. There were significant differences of anthropometric variables between those suffering from type 1 DM and their peers. The differences depended on the age at onset. The disease had a negative effect on growth with onset in prepuberty, whereas in puberty growth was satisfactory. However, puberty was a period in which patients increased their weight excessively. Prepuberty was a period in which growth had been significantly affected by metabolic control.Cilj istraživanja bio je analizirati antropometrijska obilježja u djece oboljele od tip 1 šećerne bolesti (ŠB), te tijekom petogodišnjeg praćenja u ovisnosti o stupnju pubertetskog razvoja u kojem je bolest započela te kvaliteti metaboličke kontrole bolesti. Oboljela djeca viša su od svojih vršnjaka. To se posebno odnosi na dobnu skupinu između 4 i 9,5 godina. Sveukupno tjelesna masa oboljelih i zdravih ispitanika nije se razlikovala. Međutim, oboljeli u pubertetu bili su značajno lakši negoli zdravi ispitanici. Indeks tjelesne mase bio je značajno niži u skupini oboljelih promatranoj u cjelini i u pubertetu. Tijekom petogodišnjeg praćenja bolesnici značajno zaostaju rastom. Međutim, taj se zaostatak odnosi prvenstveno na bolesnike u predpubertetu. Zaostatak u rastu je veći uz lošu metaboličku kontrolu bolesti. Ukoliko bolest započne u pubertetu rast je zadovoljavajući. Utvrđen je značajan porast tjelesne mase i to u bolesnika u pubertetu dok kod onih u predpubertetu na kraju petogodišnjeg praćenja nema značajne promjene u tjelesnoj masi. Metabolička kontrola bolesti nema utjecaja na nađene promjene. Postoje značajne razlike u antropometrijskim obilježjima između oboljelih od tip 1 ŠB i njihovih zdravih vršnjaka. Razlike ovisne o dobi u kojoj je bolest započela. Bolest ima nepovoljan utjecaj na rast ukoliko je započela u predpubertetu dok u pubetrtetu rast zadovoljava. Međutim, pubertet je razdoblje u kojem bolesnici prekomjerno povećavaju tjelesnu masu. Predpubertet je razdoblje u kojem metabolička kontrola bolesti značajno utječe na rast
Antiendomysial and antigliadin antibodies in the diagnosis of celiac disease in children of short stature
No full textBackground and Purpose: Growth failure is one of the most prominent atypical manifestations of celiac disease (CD) in childhood. The incidence of CD and diagnostic value of the proposed serologic screening tests for CD were evaluated in a group of short-statured children.
Materials and Methods: Serum antiendomysial antibodies (EMA) IgA class, antigliadin antibodies (AGA) IgA and IgG class, and total IgA were determined in 81 children with idiopathic short stature. AGA were detected by ELISA test and EMA by indirect immunofluorescence test using monkey esophagus. The patients positive for any of the serologic tests underwent small intestinal biopsy along with HLA typing.
Results: Out of ten (12.4%) seropositive patients, five (50%) were positive for all 3 tests, two (20%) for AGA IgG and EMA, two (20%) for AGA-IgG only, and one (10%) for EMA only. The two samples positive for AGA-IgG only were found out to have a selective IgA deficiency. CD was confirmed by small intestinal biopsy in all ten seropositive patients, and nine of them had celiac type HLA markers.
Conclusion: The results of our study suggest that in short statured sub jects EMA-IgA and total IgA, followed by AGA-IgG for IgA deficient samples may prove a reliable and cost-effective screening method for CD
Produljeno aktivirano parcijalno tromboplastinsko vrijeme - prikaz slučaja
No full textA case of a 75-year-old female referred to our hospital for hip replacement with preoperative laboratory test of prolonged activated partial thromboplastin time due to factor XII deficiency is described. Other coagulation parameters known to be associated with prolonged activated partial thromboplastin time like factor VIII, factor IX, factor XI, high-molecular-weight kininogen and prekallikrein were normal, and there was no evidence for the presence of unspecified circulating anticoagulants or heparin. There is a general consensus that factor XII deficiency usually does not result in hemorrhagic diathesis. Its relationship with overt venous thrombosis is still unclear. The patient and her family had no history of bleeding disorder or thromboembolic events. There was no excessive bleeding or thromboembolic incident during the surgery and postoperative recovery.Prikazan je slučaj 75-godišnje bolesnice upućene u našu bolnicu radi ugradnje umjetnog kuka s prijeoperacijskim nalazom produljenog aktiviranog parcijalnog tromboplastinskog vremena zbog nedostatka faktora XII. Drugi čimbenici koji mogu uzrokovati produljenje aktiviranog parcijalnog tromboplastinskog vremena kao faktor VIII, faktor IX, faktor XI, kininogen visoke molekularne mase i prekalikrein su bili uredni, a nije bilo znakova prisutnosti cirkulirajućih antikoagulansa niti heparina. Opći stav je da nedostatak faktora XII uglavnom ne uzrokuje krvarenje, dok je još nejasna povezanost s tromboembolijom. U bolesnice i njene obitelji nije bilo anamnestičkih podataka o poremećaju krvarenja niti tromboembolije. Za vrijeme kirurškog zahvata i u poslijeoperacijskom razdoblju nije bilo značajnog krvarenja niti tromboembolije
Analysis of the Quantitative Dermatoglyphic Traits of the Digito-Palmar Complex in Patients with Primary Open Angle Glaucoma
No full textPatient with primary open angle glaucoma (PAOG), which is known to have a genetic predisposition, and their immediate relatives unaffected with PAOG, may have some changes in dermatoglyphic traits of the digito-palmar complex, since the trabecular meshwork develops at the same time and with the same hereditary base like dermatoglyphs, which have high genetic transmission. The objective of this study is to determine whether differences in quantitative dermatoglyphic traits of the digito-palmar complex exist between patients with glaucoma and the phenotipically healthy population and whether their family members have the same dermatoglyphic changes. The quantitative dermatoglyphic traits in patients suffering from glaucoma, first-degree members of their family and the phenotypically healthy population have been screened in this study. Descriptive statistics, univariate analysis of variance (ANOVA) and post hoc (Tukey HSD) method have been used. The results have shown that there is a link between the quantitative dermatoglyphic traits of the digito-palmar complex in patients affected by glaucoma and a first-degree healthy member of their family, as well as the difference between patients with glaucoma and their first-degree relatives, which may discriminate them from the phenotypically healthy population. The results of the study mostly affirm the existence of genetic predisposition for the development of primary open-angle glaucoma, thus emphasizing the relevance of hereditary factors in the etiopathogenesis of this disease
Correlation between cyclooxygenase-2 expression and cell proliferation in invasive ductal breast cancer
No full textDijagnostičke i terapijske dvojbe kod retrobulbarnog neuritisa djeca
No full textRetrobulbar neuritis is often very complicated clinical entity. The most common cause of retrobulbar neuritis is demyelinating disease of CNS. This report is to express some other uncommon causes of it. Three children, age 8 to 12 with sudden and severe visual loss are presented. The diagnosis of retrobulbar neuritis is made by complete ophtalmological examination in consultation with neuropediatrics and neuroradiologist. Different ethiological causes of retrobulbar neuritis are found: pranasal sinusitis, functional visual loss and pseudotumor cerebri. In first two children complete therapeutically effort was as expected, and by child with pseudotumor cerebri there was no improvement of visual acuity, even after 6 months. In this presentation the authors want to emphasise some uncommon causes of retrobulbar neuritis.Retrobulbarni neuritis je složen i često teško razjašnjiv klinički entitet. Najčešće je klinički povezan s demijelinizirajućim bolestima CNS-a. Ovim radom želimo upozoriti na još nekoliko etioloških uzroka retrobulbarbog neuritisa. Na Klinici je obrađeno troje djece u dobi od 8 do 12 godina sa naglim i značajnim padom vidne oštrine pod radnom dijagnozom retrobulbarnog neuritisa. Učinjena je kompletna oftalmološka obrada u suradnji sa neuropedijatrima i neuroradiolozima. Kompletnom oftalmološkom, neuropedijatrijskom i neuroradiološkom obradom ustanove se različite etiologije bolesti: paranazalni sinusitis, funkcionalni gubitak vidne oštrine, dok se kod trećeg djeteta na osnovu dijagnostičke obrade posumnja na pseudotumor cerebri. U prva dva slučaja terapija i ishod bili su u skladu s našim očekivanjima, dok kod pseudotumora cerebri na ordiniranu terapiju nije došlo do očekivanog poboljšanja vidne oštrine (čak niti nakon 6 mjeseci). Ovim radom želimo upozoriti da kod razrješavanja slučajeva retrobulbarbog neuritisa treba posumnjati i na neuobičajene etiološke momente