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Zbrinjavanje akutnog apendicitisa tijekom pandemije COVID-19 u Hrvatskoj: iskustvo jedne ustanove
No full textThe aim of the study was to evaluate the impact of the COVID-19 pandemic on the number of patients presenting to the emergency room with acute appendicitis and subsequent results of surgical treatment. Our single center retrospective study was conducted in Sestre milosrdnice University Hospital Center, Zagreb, Croatia. We analyzed data on the patients diagnosed with acute appendicitis, their duration of symptoms, length of hospital stay, histopathologic diagnosis, and operative techniques, recorded from September 1, 2019 to October 17, 2020. The results showed a statistically significant increase in the ratio of open laparotomies (p=0.006) and ratio of perforated appendicitis (p=0.047) during the COVID-19 pandemic in relation to the pre-pandemic period. The time between symptom onset and hospitalization, measured in days, did not demonstrate a statistically
significant increase (p=0.379), and minor increase in the postoperative length of stay was not statistically significant either (p=0.879).Cilj ove studije bio je procijeniti utjecaj pandemije COVID-19 na broj bolesnika koji su dolazili u hitnu službu s akutnim apendicitisom te na rezultate daljnjeg kirurškog liječenja. Studija je provedena u KBC „Sestre milosrdnice“, Zagreb, Hrvatska.
Retrospektivno smo analizirali podatke bolesnika uključujući trajanje simptoma, duljinu hospitalizacije, patohistološku dijagnozu i operativni pristup u razdoblju od 1. rujna 2019. do 17. listopada 2020. godine. Naša studija je zabilježila statistički značajan porast udjela otvorenih laparotomija (p=0,006) te udjela perforirajućih apendicitisa (p=0,047) za vrijeme pandemije COVID-19 u odnosu na razdoblje prije pandemije. Nije bilo statistički značajnog odstupanja u vremenu od nastupa simptoma do hospitalizacije (p=0,379), kao ni statistički značajne promjene duljine hospitalizacije nakon operacije (p=0,879)
Hemodynamic Safety and Effect of Dexmedetomidine on Superficial Cervical Block Quality for Carotid Endarterectomy: A Prospective Study
No full textObjective: Dexmedetomidine as an adjuvant to local anesthetics (LAs) in regional anesthesia has demonstrated a positive effect on the quality of regional blocks, but there are no studies on usage in superficial cervical block (SCB) for carotid endarterectomy (CEA), in which the management of mean arterial pressure is essential. The authors designed a prospective, randomized, double-blinded study to investigate the effects of the addition of dexmedetomidine on the hemodynamic management and quality of SCB.
Design: A prospective, randomized, double-blinded study.
Setting: A single-center study at a university hospital center.
Participants: Ultrasound-guided SCB was performed on 60 patients classified as American Society of Anesthesiologists Grades II and III undergoing elective CEA surgery who were assigned into 2 groups randomly.
Intervention(s): Both groups received 2 mg/kg of 0.5% levobupivacaine with 2 mg/kg of 2% lidocaine. The intervention group additionally received 50 μg of dexmedetomidine.
Measurements and Main Results: The onset and duration of sensory block and analgesia, hemodynamic parameters, and adverse effects were recorded. There were minimum effects on hemodynamic parameters and no differences in the incidence of adverse effects. The time to first analgesia was longer in the intervention group than in the control group (N = 30). There was no difference in the duration of the sensory block between groups. The log-rank test indicated a significant difference in the probability of the Numeric Pain Rating Scale <3.
Conclusion: The addition of 50 μg of dexmedetomidine to 0.5% levobupivacaine and 2% lidocaine for SCB did not influence the hemodynamics and frequency of adverse effects. The median sensory block duration time showed no statistical difference between the groups, but the quality of analgesia postoperatively was much improved in the study group
Multidimenzionalnost i multidisciplinarnost kronične neuropatske neodontogene orofacijalne boli
No full textThis study compared the self-assessed health-related quality of life (HRQoL) and degree of depression between patients with chronic neuropathic nonodontogenic orofacial pain (NOFP) and healthy controls using the Short Form Survey (SF-36) health status questionnaire and Beck Depression Inventory II (BDI-II). This controlled cross-sectional study included 100 patients and 119 healthy controls. The diagnostic protocol recorded the following: 1) pain intensity using a visual analog scale for the time of examination and during the one-month prior; 2) evidence for neuropathic pain using the Leeds questionnaire for neuropathic signs and symptoms (LANSS); 3) emotional status using the BDIII; and 4) HRQoL using the SF-36 questionnaire. The mean LANSS score was 17.18 in the patient group and 0.0 in the control group. The mean BDI-II score was 18.31 in the patient group and 5.87 in the control group. The SF-36 scores were shown with Mann-Whitney U testing to have statistically significant differences between the patient and healthy control groups in all categories. Vitality was the only SF-36 category in which the patient group scored higher than the control group. In conclusion, NOFP significantly reduces the self-reported HRQoL. NOFP is also related to the development
of depression, but does not affect its severity. There is a significant correlation between depression and low quality of life in patients with NOFP.Cilj istraživanja bio je usporediti procijenjenu sa zdravljem povezanu kvalitetu života i stupanj depresije ispitanika s kroničnom neuropatskom neodontogenom orofacijalnom boli (NOFP) s rezultatima zdravih ispitanika kontrolne skupine. U studiju je uključeno 100 ispitanika srednje dobi od 56,95±13,58 godina s kliničkom dijagnozom NOFP u trajanju od najmanje šest mjeseci i 119 zdravih ispitanika srednje dobi od 57,21±13,87 godina koji su bili kontrolna skupina. Primijenjen je standardni dijagnostički protokol: 1) određivanje intenziteta boli vizualno numeričkom ljestvicom u trenutku ispitivanja te tijekom protekloga mjeseca; 2) procjena prisutnosti neuropatske boli Leedskim upitnikom neuropatskih znakova i simptoma (LANSS); 3) procjena emocionalnog statusa Beckovim inventarom depresije II (BDI-II); 4) procjena o zdravlju ovisne kvalitete života (HRQoL) upitnikom SF-36. Prosječan rezultat LANSS za skupinu oboljelih iznosio je 17,18, a za kontrolnu skupinu 0. Prosječan rezultat BDI-II u skupini oboljelih bio je 18,31 prema 5,87 u kontrolnoj skupini. Mann-Whitneyjevim U testom svaka od devet kategorija koje mjere SF-36 statistički se značajno razlikovala između bolesnih i zdravih ispitanika. U svim kategorijama osim jedne (vitalnost) kontrolna skupina imala je viši indeks u odnosu na skupinu s NOFP. Rezultat kontrolne skupine bio je veći od 60% u šest od devet kategorija, dok skupina oboljelih nije prelazila granicu od 60% niti u jednoj kategoriji. Kronična NOFP uzrokuje depresiju i utječe na gotovo sve odrednice kvalitete života mjerene upitnikom SF-36. Nije dokazan utjecaj na stupanj depresije. Postoji jaka povezanost između depresije i snižene kvalitete života oboljelih od NOFP
Koncentracija interleukina 6 i faktora tumorske nekroze alfa u slini i krvi bolesnika s neaktivnom multiplom sklerozom i supostojećim Hashimotovim tireoiditisom
No full textThe concentration of interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-α) in the blood is higher in patients with active multiple sclerosis (MS) compared to those with inactive disease. The concentration of IL-6 and TNF-α in the blood is higher in patients with Hashimoto’s thyroiditis (HT) compared to those with a healthy thyroid. The aim of the study was to assess whether
serum IL-6 and TNF-α levels correlated with saliva in patients with inactive MS and whether there was a difference in these groups of patients depending of thyroid status. We also examined the correlation of thyroid stimulating hormone (TSH) levels with thyroid status. The study included 54 patients in the inactive phase of MS. The level of cytokines in the blood was determined by chemiluminescence, and in saliva by ELISA. Blood and saliva IL-6 levels showed positive correlation, while blood and saliva TNF-α
levels were not correlated. There was a significantly higher TSH level in patients with inactive MS with positive thyroid antibodies, without therapy, compared with those with negative antibodies.Koncentracija interleukina 6 (IL-6) i faktora tumorske nekroze alfa (TNF-α) u krvi je veća u bolesnika s aktivnom multiplom sklerozom (MS) u odnosu na one s neaktivnom bolešću. Koncentracija IL-6 i TNF-α u krvi je veća kod bolesnika s Hashimotovim tireoditisom (HT) u odnosu na one sa zdravom štitnjačom. Cilj istraživanja bio je procijeniti koreliraju li serumske razine IL-6 i TNF-α s onima u slini kod bolesnika s neaktivnom MS i postoji li razlika među navedenim skupinama bolesnika ovisno o statusu štitnjače. Također smo ispitali korelaciju razine tireoidnog stimulirajućeg hormona (TSH) sa statusom štitnjače kod svih bolesnika. U istraživanje su uključena 54 bolesnika u neaktivnoj fazi MS. Razina citokina u krvi je određena metodom kemiluminiscencije, a u slini metodom ELISA. Pozitivno je korelirala razina IL-6 u krvi i slini, dok razina TNF-α u krvi i slini nije korelirala. Značajno je veća bila razina TSH u bolesnika s neaktivnom MS s pozitivnim protutijelima na štitnjaču, bez terapije, u odnosu na one s negativnim protutijelima
Sebacealni karcinom vjeđe i Muir-Torreov sindrom
No full textMuir-Torre syndrome is a rare form of hereditary nonpolyposis colorectal cancer syndrome; simplified, it is an association of at least one sebaceous skin tumor and at least one visceral malignancy. It follows an autosomal dominant pattern of inheritance. We present a case of a recurrent sebaceous carcinoma of the eyelid in a patient previously operated on for colorectal carcinoma. During his treatments, he was examined by experts in different medical fields. After genetic counseling, he also underwent genetic testing.Muir-Torreov sindrom je rijedak oblik nasljednog sindroma nepolipoznog kolorektalnog karcinoma koji zapravo objedinjuje barem jedan sebacealni karcinom kože i jedan visceralni zloćudni tumor. Nasljeđuje se autosomno dominantno. Prikazujemo slučaj bolesnika s recidivirajućim sebacealnim karcinomom vjeđe prethodno operiranog zbog kolorektalnog karcinoma. Tijekom liječenja bolesnika je obradio oftalmolog koji ga upućuje na širu obradu i konačno na genetsko savjetovanje kada je odlučeno da se bolesnik podvrgne genetičkom testiranju
The Role of Thermal Camera in the Assessment of Thyroid Eye Disease Activity
No full textBackground: Thyroid eye disease (TED; also known as thyroid - associated orbitopathy, Graves ophthalmopathy) is an autoimmune inflammatory disease which presents in typical signs and symptoms such as deep orbital pain, chemosis with or without caruncular edema, unilateral or bilateral proptosis, eyelid retraction, eyelid edema or erythema, restrictive strabismus and compressive optic neuropathy. Objective: The aim of this study was to investigate the role of thermal camera in the assessment of thyroid eye disease (TED) activity compared to the Clinical Activity Score (CAS) scale, exophthalmometry values, and thyroid hormone and antibody levels. Methods: A total of 50 patients participated in this cross-sectional study of whom 29 were in the active phase of TED according to the sum on CAS scale and 21 patients in the inactive phase. The Flir E8® thermal camera was used to measure the temperature of the orbital area and the values were compared with the CAS scale, exophthalmometry values and thyroid hormone and antibody levels. Results: Higher values of temperature (p>0.0001), CAS score (p>0.0001), exophthalmometry (p=0.022), FT4 (p=0.0176) and TRAb (p=0.0091) were found in patients in the active phase of TED. Temperature of orbital area showed statistically significant positive correlation with CAS scale (p=0.0001), exophthalmometry values (p=0.0022) and anti-TPO levels (p=0.019). Conclusion: Thermal camera showed higher values of the temperature of the orbital area in patients in the active phase of the disease and positively correlated with the CAS scale, exophthalmometry findings and anti-TPO levels
Hinge craniotomy as an alternative technique for patients with refractory intracranial hypertension
No full textIntroduction: Decompressive craniectomy (DC) can save brain tissue, but unfortunately it has many limitations and complications. Hinge craniotomy (HC), as less aggressive method seems to be adequate alternative not only to DC but also to conservative treatment.
Research question: Presentation of the results of modified surgical techniques of cranial decompression and comparing with more and less aggressive medical options.
Material and methods: A prospective clinical study was conducted during 86 months. Comatose patients who suffered refractory intracranial hypertension (RIH) were treated. Altogether, 137 patients have been evaluated. The final outcome of all patients in the study was evaluated after 6 months.
Results: Both surgical options resulted in adequate control of intracranial pressure (ICP). HC method was shown to have the lowest probability of worsening from a prior state of relative stability.
Discussion and conclusion: There was no statistically significant difference between methods to treatment of DC or HC, meaning the final outcome of patients treated in any manner. There was similar rate of early and late complications
Application of Fruit By-Products and Edible Film to Cookies: Antioxidant Activity and Concentration of Oxidized LDL Receptor in Women—A First Approach
No full textCookie consumption can change the serum level of oxidized low-density lipoprotein (oxLDL) and oxLDL receptors, both playing important roles in the pathogenesis of atherosclerosis and cardiovascular diseases. This study investigated the nutritional value and the antioxidant activity of whole grain cookies in which 24% of the cocoa powder was substituted with grape and aronia pomace and were further coated with edible films enriched with grape seed extract (GAP with KGAE) as well as the effects of their consumption on the serum level of oxLDL receptors in women. The proximate composition, mineral content, antioxidant activity, and starch digestibility in vitro of experimental and control cookies were determined. A group of 12–13 healthy women (median age 36) consumed 45 g of GAP with KGAE or commercial cookies for 10 days. The results showed that GAP and KGAE cookies had increased flavonoid content (22%) and antioxidant potential (27–73%) compared to the control. The content of slowly digestible starch prevailed over rapidly digestible starch. The serum concentrations of the oxLDL receptors between the test and control groups were similar. We can conclude that the moderate consumption of whole grain cookies with fruit by-products does not lead to the formation of oxLDL receptors in healthy women
Rijetki intrakranijski multifokalni ne-germinomatozni tumor zametnih stanica kod 18-godišnjeg mladića: prikaz slučaja
No full textIntracranial germ cell tumors are rare brain tumors that are distinguished based on their histology and selected tumor markers. Non-germinomatous germ cell tumors are a diverse group of such tumors having the poorest prognosis. Most commonly, they are located in the suprasellar and pineal regions. Since the exact treatment protocol has not yet been established, there is currently no standardized modality of management. We present a case of intracranial multifocal non-germinomatous germ cell tumor in an 18-year-old male, along with relevant literature review. We describe initial diagnostic and treatment procedures in a young adult presented with diplopia and ataxic gait. Neuroradiological findings and elevated alpha fetoprotein and beta chain of the human chorionic gonadotropin tumor markers indicated the possible mixed germ cell tumor. Chemotherapy regimen was adjusted accordingly, biopsy was not performed. The patient’s clinical condition improved significantly and his alpha fetoprotein values decreased remarkably after initiation of chemotherapy. In conclusion, initial evaluation with neuroimaging, tumor markers, and cytology from cerebrospinal fluid is important as guidance to further treatment and prognosis. In selected cases, biopsy may not be indicated to start adjuvant chemotherapy. We emphasize the importance of specific treatment modality selection based mainly on tumor markers, regardless of the precise histologic classification.Intrakranijski tumori zametnih stanica su rijetki tumori mozga koji se razlikuju na temelju histologije i tumorskih biljega. Ne-germinomatozni tumori zametnih stanica su raznolika podskupina tih tumora s najlošijom prognozom. Najčešće su locirani u supraselarnoj i pinealnoj regiji. S obzirom na to da točan protokol liječenja još nije utemeljen trenutno ne postoji standardizirani način liječenja. Predstavljamo slučaj intrakranijskog multifokalnog ne-germinomatoznog tumora zametnih stanica kod 18-godišnjeg mladića, popraćen relevantnim pregledom literature. Opisali smo početne dijagnostičke i terapijske postupke provedene kod mladića koji se prezentirao diplopijom i ataksičnim hodom. Neuroradiološki nalazi i povišeni tumorski biljezi, alfa fetoprotein te beta lanac humanog korionskog gonadotropina, upućivali su na mogući miješani tip tumora zametnih stanica. Propisana je odgovarajuća kemoterapija, a biopsija nije učinjena. Nakon početka kemoterapije bolesnikovo kliničko stanje se iznimno popravilo te su mu se vrijednosti alfa fetoproteina značajno snizile. Zaključno, početna neuroradiološka obrada, nalaz tumorskih biljega i citologija iz likvora važni su čimbenici u određivanju smjera liječenja i predviđanju prognoze. U određenim slučajevima biopsija ne mora biti indicirana kako bi se započelo s kemoterapijom. Naglašavamo važnost odabira specifičnog načina liječenja prvenstveno na temelju nalaza tumorskih biljega bez obzira na preciznu histološku klasifikaciju
Expression Pattern of DAB Adaptor Protein 2 in Left- and Right-Side Colorectal Carcinoma
No full textLeft-sided and right-sided colorectal cancer (L-CRC and R-CRC) have relatively different clinical pictures and pathophysiological backgrounds. The aim of this study was to investigate the presence of DAB adapter protein 2 (DAB2) as a potential molecular mechanism that contributes to this diversity in terms of malignancy and responses to therapy. The expression of the suppressor gene DAB2 in colon cancer has already been analyzed, but its significance has not been fully elucidated. Archived samples from 34 patients who underwent colon cancer surgery were included in this study, with 13 patients with low-grade CRC and 21 with high-grade CRC. Twenty of the tumors were R-CRC, while 14 were L-CRC. DAB2 expression was analyzed immunohistochemically in the tumor tissue and the colon resection margin was used as a control. Tumors were divided into L-CRC and R-CRC, with splenic flexure as the cutoff point for each side. The results showed that R-CRC had lower DAB2 protein expression compared to L-CRC (p = 0.01). High-grade tumors had reduced DAB2 expression compared to low-grade tumors (p = 0.02). These results are consistent with the analysis of DAB2 gene expression data that we exported from the TCGA Colon and Rectal Cancer Study (COADREAD). In 736 samples of colon cancer, lower DAB2 gene expression was found in R-CRC compared to L-CRC (p < 0.0001). DAB2 gene expression was significantly higher in the sigmoid colon than in the cecum and ascending colon (p < 0.01). The analysis confirmed a lower expression of the DAB2 in tumors with positive microsatellite instability (p < 0.001). In conclusion, DAB2 has a role in the biological differences between R-CRC and L-CRC and its therapeutic and diagnostic potential needs to be further examined