Veterinary medicine - Repository of PHD, master's thesis
Veterinary medicine - Repository of PHD, master's thesisNot a member yet
9490 research outputs found
Sort by
Reducing invasiveness in liver surgery-where is the limit?
No full textIn this article, we comment on the article by Wang et al published in the recent issue of the World Journal of Gastroenterology Surgery . Most prominent advancements in liver surgery in the last two decades are related to refinements in surgical technique (extraglissonean approach) and advancements in surgical technology (laparoscopy and robotics). In this article, authors present both these aspects: Laparoscopic segmentectomy using extraglissonean approach. Furthermore, they describe segmental resections of all 8 segments which is the main novelty that can be observed in the article. By now, extraglissonean approach was thoroughly described mainly in hepatectomies or lateral sectionectomies. Various “hilar gates” are defined which allows safe liver resection by ligating Glissonean pedicles first which is then followed by parenchymal resection. We here focus on past, present and future perspectives of extraglissonean approach and laparoscopic liver resections and comment the value of the presented article
Interleukin 1 beta in inner carotid artery atherosclerosis
No full textMoždani je udar po učestalosti drugi uzrok smrtnosti u svijetu i Republici Hrvatskoj. Jedan od mehanizama njegova nastanka ishemija je područja opskrbe unutarnje karotidne arterije uzrokovana stenozom na mjestu odvajanja od zajedničke unutarnje karotidne arterije. Zahvat koji se u vaskularnoj kirurgiji provodi u liječenju ove bolesti je karotidna endarterektomija (engl. carotid endarterectomy, CEA) kojom se mehanički odstranjuje plak iz arterije. CEA se u asimptomatskih bolesnika (koji su bez neurološkog ispada unazad 6 mjeseci) vrši kao prevencija moždanog udara, ali i sama nosi određeni rizik od akutnog moždanog udara i smrti. Prema važećim preporukama Europskog društva za vaskularnu kirurgiju (engl. European Society for Vascular Surgery, ESVS) iz 2023. g. kirurško se liječenje u asimptomatskih bolesnika preporučuje kod onih sa stenozom između 60-99 % uz povišen klinički ili radiološki utvrđen rizik od moždanog udara. Ipak, postoje asimptomatski bolesnici sa stenozom nižeg stupnja koji u nekom trenutku pretrpe moždani udar uzrokovan karotidnom stenozom, a koje je teško unaprijed probrati. Kako bi se taj probir potkrijepio dodatnim medicinskim nalazima, znanstvena zajednica traga za biljezima iz krvi koji bi u kombinaciji s postojećim metodama pokazali koji bi pacijenti s nižim stupnjem stenoze imali koristi od CEA-e. Ovo istraživanje prikazalo je obećavajući potencijal IL-1 beta u dijagnostici, ali i liječenju karotidne stenoze te je i svojevrstan poticaj za usmjeravanje daljnjih istraživanja u smjeru spomenutog biljega u kontekstu karotidne stenoze.Stroke is the second leading cause of death worldwide and in the Republic of Croatia. One of its pathogenetic mechanisms is the ischaemia of the inner carotid artery area caused by stenosis of its origin – the bifurcation of the common carotid artery. One of the modalities of its treatment is the procedure called carotid endarterectomy (CEA) performed by vascular surgeons in which the atherosclerotic plaque is mechanically removed. It is, among other cases, indicated in patients with asymptomatic carotid stenosis (those who haven't suffered from a neurological incident in the past 6 months) as a prevention of stroke, although it carries the risk of stroke and death. By the European Society for Vascular Surgery’s newest guidelines, CEA is indicated when asymptomatic patents have stenosis 60-99% with at least one clinical or radiological risk factor for stroke. However, some asymptomatic patients with lower stenosis also develop stroke, which is currently impossible to predict. In order to screen the patients with lower stenoses that could benefit from CEA, the scientific community is in search for blood biomarkers that show the ability of identifying those patients, together with the existing methods. This research shows promising potential of IL-1 beta in both diagnostics and treatment of carotid stenosis and also presents encouragement in further investigations on IL-1 beta in the context of carotid stenosis
Eosinophilic esophagitis
No full textEozinofilni ezofagitis (EoE) je kronična, imunološki posredovana upalna bolest jednjaka obilježena infiltracijom eozinofila u sluznici jednjaka te simptomima ezofagealne disfunkcije, najčešće u obliku disfagije i impakcije hrane. Iako je prvi put opisana tek krajem 20. stoljeća, učestalost EoE-a posljednjih je desetljeća značajno porasla, osobito u razvijenim zemljama, čime se bolest sve više prepoznaje kao važan uzrok simptoma iz gornjeg dijela gastrointestinalnog trakta, kako u djece, tako i u odraslih. Često je udružena s atopijskim bolestima, poput astme, alergijskog rinitisa i atopijskog dermatitisa.
Dijagnoza EoE-a postavlja se na temelju kliničke slike, endoskopskih nalaza i histološke potvrde ≥15 eozinofila po velikom vidnom polju (VVP) u bioptatu sluznice jednjaka. U kliničkoj praksi koristi se sustav za bodovanje endoskopskih promjena
(EREFS) te histološki sustav bodovanja (EoEHSS) koji omogućuju standardiziranu procjenu aktivnosti i težine bolesti.
Terapija EoE-a temelji se na tri glavna pristupa: dijetetskoj eliminaciji okidača (elementarna dijeta, empirijske i testiranjem vođene eliminacijske dijete), farmakološkoj terapiji (topički glukokortikoidi i inhibitori protonske pumpe) te mehaničkoj endoskopskoj dilataciji u bolesnika sa stenozama jednjaka. Izbor terapije ovisi o kliničkom kontekstu, preferencijama bolesnika i dostupnosti resursa, pri čemu se sve češće preporučuje dugoročno liječenje radi postizanja i održavanja remisije bolesti.
Unatoč napretku u dijagnostici i liječenju, mnogi aspekti bolesti, uključujući optimalnu strategiju praćenja i dugoročnog liječenja, još uvijek nisu jasno definirani. Cilj ovog rada je prikazati trenutačne spoznaje o prevalenciji, kliničkim manifestacijama,
dijagnostičkim kriterijima i terapijskim mogućnostima u bolesnika s eozinofilnim ezofagitisom, s naglaskom na multidisciplinarni pristup i važnost individualizirane terapije.Eosinophilic esophagitis (EoE) is a chronic, immune-mediated inflammatory disease of the esophagus characterized by eosinophilic infiltration of the esophageal mucosa and symptoms of esophageal dysfunction, most commonly in the form of dysphagia and food impaction. Although it was first described only in the late 20th century, the prevalence of EoE has increased significantly in recent decades, particularly in developed countries, making it an increasingly recognized cause of upper gastrointestinal symptoms in both children and adults. It is frequently associated with atopic conditions such as asthma, allergic rhinitis, and atopic dermatitis. Diagnosis is based on clinical presentation, endoscopic findings, and histological confirmation of ≥15 eosinophils per high-power field in esophageal mucosal biopsies. In clinical practice, standardized tools such as the Endoscopic Reference Score (EREFS) and the EoE Histology Scoring System (EoEHSS) are used to assess disease activity and severity.
Treatment is based on three main strategies: dietary elimination of triggers (elemental diet, empiric and test-based elimination diets), pharmacologic therapy (topical corticosteroids and proton pump inhibitors), and mechanical endoscopic dilation in patients with esophageal strictures. Treatment choice depends on the clinical context, patient preferences, and available resources, with long-term therapy increasingly recommended to maintain remission.
Despite significant progress in diagnosis and management, several aspects of EoE remain unclear, including optimal follow-up and long-term treatment strategies. The aim of this paper is to provide an overview of current knowledge on the epidemiology, clinical presentation, diagnostic criteria, and treatment options for eosinophilic esophagitis, with emphasis on a multidisciplinary approach and the need for individualized therapy
Ultrasound diagnosis of malformations in multiple pregnancies
No full textVišeplodne trudnoće nose znatno veći rizik nepovoljnog ishoda u odnosu na jednoplodne trudnoće, a ultrazvučni je nadzor najvažnija metoda antenatalne skrbi. Osim što se njime u prvom tromjesečju određuju korionicitet i amnionicitet, o kojima ovise vrsta i opseg pojedinih fetalnih abnormalnosti, ultrazvuk služi i za procjenu rizika od kromosomskih i strukturnih malformacija fetusa. Pritom se u probirima na abnormalnosti u prvom tromjesečju radi što veće pouzdanosti ultrazvučni nalaz kombinira s vrijednostima specifičnih serumskih markera iz majčine krvi, a danas se sve češće koriste i dodatne neinvazivne dijagnostičke metode poput neinvazivnog prenatalnog testa kojim se analizom slobodne fetalne DNA u majčinoj cirkulaciji također procjenjuje rizik od najčešćih kromosomskih abnormalnosti fetusa. U drugom tromjesečju ultrazvuk je važan za procjenu fetalne biometrije i pregled svakog fetusa po organskim sustavima, čime se omogućuje prepoznavanje strukturnih anomalija, ali i drugih poremećaja poput intrauterinog zastoja u rastu jednog ili oba fetusa. Osim standardnog dvodimenzionalnog prikaza, ultrazvuk omogućava i procjenu protoka kroz krvne žile. To također služi procjeni rizika za kromosomopatije u ranoj trudnoći, ali isto tako može ukazati na postojanje izoliranih ili sindromskih strukturnih anomalija fetusa tijekom cijele trudnoće. Trodimenzionalni i četverodimenzionalni ultrazvučni prikaz omogućuju prikaz volumena tijela fetusa u stvarnom vremenu, no zbog svojih ograničenja danas se još uvijek smatraju dodatnim dijagnostičkim metodama. Za monokorionske biamnijske trudnoće specifične su komplikacije poput sindroma transfuzije krvi između blizanaca zbog anastomoza krvnih žila posteljice, koje mogu uzrokovati teške hemodinamske poremećaje u blizanaca, a time i intrauterinu smrt jednog ili oba fetusa. U monoamnijskih blizanaca česta je i iznenadna intrauterina smrt fetusa zbog zapetljavanja pupkovina. U svih blizanačkih trudnoća intenzivan ultrazvučni nadzor ima važnu ulogu u ranom otkrivanju poremećaja, praćenju stanja fetusa te planiranju terapijskih postupaka.Multiple pregnancies are associated with an increased risk of perinatal mortality and morbidity. Ultrasound monitoring is the most important method of antenatal care. In addition to determining chorionicity and amnionicity in the first trimester, which influence the type and extent of fetal abnormalities, ultrasound is also used to assess the risk of chromosomal and structural fetal malformations. To improve diagnostic accuracy in first-trimester screening, ultrasound findings are combined with maternal serum biomarkers, while non-invasive prenatal testing, which analyzes cell-free fetal DNA in maternal blood, are also used to assess the risk of common chromosomal abnormalities. In the second trimester, ultrasound is important for fetal biometry assessment, as well as systematic organ evaluation, enabling the detection of structural anomalies and conditions such as intrauterine growth restriction of one or both fetuses. In addition to standard two-dimensional imaging, Doppler ultrasound is used to assess blood flow, providing further insight into the risk of chromosomal abnormalities and the presence of isolated or syndromic fetal malformations throughout pregnancy. Three-dimensional (3D) and four-dimensional (4D) imaging allow real-time visualization of fetal body volumes. However, due to current limitations, these methods still remain adjunct diagnostic tools. Monochorionic diamniotic pregnancies are at heightened risk for complications such as twin-to-twin transfusion syndrome, caused by placental vascular anastomoses, which may lead to severe hemodynamic imbalance and result in the intrauterine death of one or both fetuses. In monoamniotic twins, sudden intrauterine death may also be caused by umbilical cord entanglement. Intensive ultrasound monitoring plays a crucial role in the early detection of complications, fetal assessment, and timely planning of therapeutic interventions in all twin pregnancies
Hearing Rehabilitation in Patients with Treacher Collins Syndrome
No full textTreacher Collins sindrom (TCS) rijetka je nasljedna kraniofacijalna dizostoza koja se javlja u otprilike jednom od pedeset tisuća poroda. Širok spektar kliničkih manifestacija posljedica je poremećaja u razvoju struktura prvog i drugog škržnog luka tijekom embrionalnog razvoja. Obzirom na fenotipsku varijabilnost potreban je multidisciplinaran dijagnostički i terapijski pristup. Jedan od istaknutih problema u bolesnika s TCS-om jest konduktivno oštećenje sluha (CHL) s udjelom koji varira ovisno o literaturi od 83 do 92%. CHL značajno utječe na razvoj jezika i govora te tako komunikacije, socijalne interakcije i općeg psihosocijalnog razvoja, a osobito u pedijatrijskoj populaciji. Napretkom tehnologije slušnih pomagala, uključujući uređaje za koštano provođenje zvuka (BCHD) i aktivne implantate srednjeg uha (AMEI), omogućena je bolja rehabilitacija sluha bolesnika, posebice u onih u kojih se konvencionalna slušna pomagala nisu pokazala učinkovitima ili nisu prikladna zbog anatomskih ograničenja. Također je dan kratak osvrt na etiopatogenezu i kliničku sliku TCS-a i CHL-a uz prikaz anatomskih, fizioloških i dijagnostičkih osnova otologije i audiologije. Istaknuta je važnost pravodobne dijagnoze, odabira odgovarajućeg slušnog pomagala i multidisciplinarne suradnje u rehabilitaciji sluha poradi optimizacije kvalitete života bolesnika s TCS-om. Iako podaci različitih studija pokazuju poboljšanje sluha i razumijevanja govora korištenjem novih tehnologija u rehabilitaciji, potrebno je prikupiti više podataka kako bi se mogle dati opće preporuke za liječenje CHL-a kod bolesnika s TCS-om.Treacher Collins syndrome (TCS) is a rare hereditary craniofacial dysostosis that occurs in approximately one in fifty thousand live births. The wide spectrum of clinical manifestations results from the disrupted development of the structures derived from the first and second pharyngeal arches during embryogenesis. Due to the phenotypic variability, a multidisciplinary diagnostic and therapeutic approach is required. One of the prominent issues in patients with TCS is conductive hearing loss (CHL), with prevalence varying in the literature from 83% to 92%. CHL significantly affects language and speech development, influencing communication, social interaction, and overall psychosocial development, particularly in the pediatric population. Advancements in hearing aid technology, including bone conduction hearing devices (BCHD) and active middle-ear implants (AMEI), have enabled more effective hearing rehabilitation, especially in patients for whom conventional hearing aids are either ineffective or anatomically unsuitable. The thesis also provides a brief overview of the etiopathogenesis and clinical features of TCS and CHL, along with the anatomical, physiological, and diagnostic foundations of otology and audiology. The importance of timely diagnosis, appropriate hearing aid selection, and multidisciplinary collaboration in hearing rehabilitation is emphasized, with the ultimate goal of optimizing the quality of life for patients with TCS. Although data from various studies indicate improvements in hearing and speech comprehension through the use of advanced hearing technologies, further research and data collection are needed to establish general recommendations for the treatment of CHL in TCS patients
Regional anesthesia for Cesarean section
No full textCarski rez je kirurški zahvat kojim se dijete porađa kroz inciziju trbušne stijenke i maternice. Izvodi se kada vaginalni porođaj predstavlja rizik za majku ili dijete te se dijeli u nekoliko kategorija s obzirom na stupanj hitnoće. Unatoč sve većoj učestalosti i sigurnosti zahvata, carski rez nosi brojne potencijalne rizike, uključujući ozljede mokraćnog mjehura i/ili crijeva, krvarenje, infekcije, tromboembolijske incidente te komplikacije u budućim trudnoćama poput rupture maternice i poremećaja implantacije posteljice. Za izvođenje carskog reza koriste se tri glavne metode anestezije: opća, regionalna (spinalna, epiduralna i kombinirana spinalno-epiduralna) te rijetko lokalna infiltracijska anestezija. Tehnike regionalne anestezije smatraju se metodama izbora zbog niže stope komplikacija u odnosu na opću anesteziju, brze primjene, bolje postoperativne analgezije i mogućnosti da majka bude budna tijekom porođaja. Opća anestezija koristi se uglavnom kod prvog stupnja hitnoće ili kada postoje kontraindikacije za regionalnu anesteziju, poput koagulopatije, infekcije na mjestu uboda, povišenog intrakranijalnog tlaka ili odbijanja pacijentice.A Cesarean section is a surgical procedure in which a fetus is delivered through incisions made in the abdominal wall and uterus. It is performed when vaginal birth poses a risk to the mother or fetus and can be classified into few categories depending on the degree of emergency. Although the procedure is increasingly performed and considered safe, it still carries potential risks including injury to nearby organs such as bladder and intestines, bleeding, infections, thromboembolic events, and long-term complications in future pregnancies such as uterine rupture and abnormal placentation. Three primary types of anesthesia are used for cesarean delivery: general, regional (spinal, epidural, and combined spinal-epidural), and, rarely, local infiltration anesthesia. Techniques of regional anesthesia are considered to be methods of choice because of their lower complication rates compared to general anesthesia, rapid administration, superior postoperative analgesia and the ability for the mother to remain awake during delivery. General anesthesia is mainly reserved for first degree of urgency cesarean section or due to contraindications for regional anesthesia, such as coagulopathy, infection at the puncture site, increased intracranial pressure or patient refusal
Physical therapy in the treatment of compressive neuropathy of the hand
No full textKompresivne neuropatije šake česta su stanja u općoj populaciji koja nastaju kompresijom perifernih živaca u području ručnog zgloba. Najčešća kompresivna neuropatija je sindrom karpalnog kanala, a značajni su i sindrom Guyonova kanala i Wartenbergov sindrom. Sindrom karpalnog kanala nastaje kompresijom n. medianusa unutar karpalnog tunela. Živac ima senzoričku i motoričku komponentu stoga se klinički prezentira sa poremećajem motiliteta, poremećajima pri hvatanju palcem, atrofijom tenara hipoestezijom, parestezijama i boli. Sindrom Guyonova kanala nastaje kompresijom n. ulnarisa unutar ulnarnog kanala koji je podijeljen na tri zone ovisno o tome koja je grana živca zahvaćena, a posljedično tome prisutni su i određeni simptomi (senzorni, motorički ili senzorni i motorički). Wartenbergov sindrom je kompresivna neuropatija nastala kompresijom površinske grane n. radialisa. Budući da je to isključivo senzorna grana, nisu prisutni motorički simptomi, stoga se pojavljuju samo senzorni simptomi poput boli i parestezija. Kompresivne neuropatije mogu se liječiti konzervativnim metodama (fizikalna terapija) i kirurški. Konzervativne metode su prva linija liječenja blagih do umjerenih oblika neuropatija, a kirurškom liječenju pristupa se kod teških oblika. Od konzervativnih metoda primjenjuju se farmakološke metode (glukokortikoidne injekcije) i brojne nefarmakološke metode poput kineziterapije, udlaga za imobilizaciju ekstremiteta, akupunkture, ultrazvuka, udarnog vala, lasera, TENS-a, iontoforeze i elektromagnetoterapije. Svaka metoda ima svoj specifičan mehanizam djelovanja i primjenjuju se lokalno. Brojne studije pokazale su učinkovitost konzervativnih metoda u modulaciji boli i poboljšanju funkcije šake kod CTS-a. Osim toga pokazano je da kombinacije metoda daju bolje rezultate nego svaka pojedinačno. Fizikalna terapija, zbog svoje neinvazivnosti i minimalnih nuspojava, predstavlja ključnu komponentu u liječenju kompresivnih neuropatija šake i trebaju biti prvi izbor liječenja prije donošenja odluke o kirurškom zahvatu.
Ključne riječi: kompresivne neuropatije, sindrom karpalnog kanala, konzervativne metode, kirurško liječenje, fizikalna terapijaCompressive neuropathies of the hand are common conditions in the general population that result from compression of peripheral nerves in the wrist area. The most common compressive neuropathy is carpal tunnel syndrome and Guyon's canal syndrome and Wartenberg's syndrome are also significant. Carpal tunnel syndrome is caused by compression of the median nerve within the carpal tunnel. The nerve has a sensory and motor component, therefore it clinically presents with motility disorders, thumb grip disorders, thenar atrophy with hypoesthesia, paresthesias and pain. Guyon's canal syndrome is caused by compression of the ulnar nerve within the ulnar canal, which is divided into three zones depending on which branch of the nerve is affected and consequently certain symptoms are present (sensory, motor or sensory and motor). Wartenberg's syndrome is compressive neuropathy caused by compression of the superficial branch of the radial nerve. Since it is exclusively a sensory branch, motor symptoms are not present, therefore only sensory symptoms such as pain and paresthesia appear. Compressive neuropathies can be treated conservatively (physical therapy) and surgically. Conservative methods are the first line of treatment for mild to moderate forms of neuropathies and surgical treatment is used for severe forms. Conservative methods include pharmacological methods (glucocorticoid injections) and numerous non-pharmacological methods such as kinesitherapy, splints for immobilization of extremities, acupuncture, ultrasound, shock wave, laser, TENS, iontophoresis and electromagnetic therapy. Each method has its own specific mechanism of action and is applied locally. Numerous studies have shown the effectiveness of conservative methods in modulating pain and improving hand function in CTS. In addition, it has been shown that combinations of methods provide better results than each method alone. Physical therapy, due to its non-invasiveness and minimal side effects, is a key component in treatment of compressive hand neuropathies and should be the first choice of treatment before making a decision about surgical intervention
New insights into neoadjuvant chemotherapy in the treatment of invasive cervical cancer during pregnancy
No full textInvazivni karcinom vrata maternice dijagnosticiran tijekom trudnoće predstavlja iznimno složen klinički izazov koji zahtijeva multidisciplinarni pristup, primjenu standardne onkološke skrbi i pomno opstetričko praćenje. Iako je riječ o rijetkoj dijagnozi, broj slučajeva u porastu je zbog trendova odgađanja prve trudnoće i napretka u antenatalnoj dijagnostici. Donedavno je primarna terapijska opcija uključivala prekid trudnoće kako bi se omogućilo pravovremeno onkološko liječenje. Međutim, uvođenjem neoadjuvantne kemoterapije (NAKT) otvorena je mogućnost zadržavanja trudnoće do fetalne zrelosti, uz kontrolu tumorske bolesti. Dosadašnja istraživanja ukazuju na dobru podnošljivost paklitaksela i karboplatine tijekom drugog i trećeg tromjesečja te na zadovoljavajuće onkološke i neonatalne ishode, uz nisku učestalost kongenitalnih malformacija i perinatalnih komplikacija. Većina invazivnih karcinoma nastaje iz preinvazivnih lezija koje su posljedica HPV infekcije visokorizičnim tipovima i integracije virusnog genoma u epitelne stanice. Nakon sumnje na karcinom vrata maternice, prihvatljivi dijagnostički postupci u trudnoći uključuju citologiju, kolposkopiju i ciljanu biopsiju, dok se za određivanje stadija bolesti preferira magnetska rezonancija bez kontrasta. Ključno je procijeniti proširenost bolesti i status limfnih čvorova kako bi se pravodobno odabrao optimalan terapijski pristup. Nakon primjene kemoterapije u trudnoći, posebno je važno pomno isplanirati termin poroda, nakon poroda učiniti patohistološku analizu posteljice te dugoročno pratiti djecu izloženu citostaticima in utero. Prevencija bolesti i dalje ostaje ključna, s naglaskom na važnost HPV cijepljenja i redovitih probira. Rad donosi najnovije spoznaje koje potkrepljuju sigurnost i učinkovitost NAKT-a kao alternativnog pristupa u liječenju ove kompleksne dijagnoze.Invasive cervical cancer diagnosed during pregnancy represents a highly complex clinical challenge that requires a multidisciplinary approach, adherence to standard oncological care, and close obstetric monitoring. Although rare, the number of cases is increasing due to delayed childbearing and advancements in antenatal diagnostics. Until recently, pregnancy termination was the standard therapeutic approach to allow timely oncological treatment. However, the
introduction of neoadjuvant chemotherapy (NACT) has made it possible to maintain the pregnancy until fetal maturity while keeping the disease under control. Current studies show good tolerability of paclitaxel and carboplatin during the second and third trimesters, with satisfactory oncological and neonatal outcomes and a low incidence of congenital malformations
and perinatal complications. Most invasive carcinomas develop from preinvasive lesions caused by high-risk HPV types, following viral genome integration into epithelial cells. Upon suspicion of cervical cancer, acceptable diagnostic procedures during pregnancy include cytology, colposcopy, and targeted biopsy, while non-contrast magnetic resonance imaging is preferred for disease staging. Accurate assessment of disease extent and lymph node status is essential to determine the optimal treatment plan. After chemotherapy administration during pregnancy, careful planning of delivery timing, histopathological examination of the placenta after delivery, and long-term follow-up of children exposed to cytotoxic agents in utero are crucial. Disease prevention remains essential, emphasizing the importance of HPV vaccination and regular
screening. This paper presents the latest findings supporting the safety and effectiveness of NACT as an alternative approach in the treatment of this complex diagnosis
Diagnostics and treatment of malignant ovarian tumors
No full textZloćudne novotvorine jajnika vrlo su heterogena skupina tumora i predstavljaju značajan klinički izazov. Zbog nespecifičnih simptoma u ranom stadiju bolesti, karakterizira ih kasno otkrivanje i loša ukupna prognoza. Dijagnostički postupak uključuje temeljito uzimanje anamneze, fizikalni pregled, mjerenje tumorskih markera te slikovnu obradu. Transvaginalni ultrazvuk prva je metoda izbora u slikovnoj dijagnostici, a nakon njega slijede CT, MR, ili PET CT. Točno određivanje stadija ključni je korak u odabiru optimalnog terapijskog postupka. Liječenje se temelji na kirurškom zahvatu i kemoterapiji, a u terapiji održavanja
mogu se primjenjivati inhibitori PARP enzima i antiangiogena terapija. Kod mladih žena u fertilnoj dobi, ukoliko je moguće, izvode se poštedni zahvati u svrhu očuvanja plodnosti. U slučaju recidiva bolesti, terapija se individualno prilagođava, ovisno o dobi i općem stanju pacijentice te vremenu pojave relapsa i prethodnom odgovoru na terapiju.Malignant ovarian tumors are a highly heterogenous group of neoplasms and represent a significant clinical challenge. Due to non-specific symptoms in the early stages of the disease, they are often diagnosed at an advanced stage, which is associated with poor overall prognosis. The diagnostic process includes a thorough medical history, physical examination, tumor marker assessment, and imaging. Transvaginal ultrasound is the first-line imaging modality, followed by CT, MRI, or PET CT, if needed. Accurate staging is a key step in selecting the optimal therapeutic approach. Treatment is based on surgery and chemotherapy, while maintenance therapy may include PARP inhibitors and antiangiogenic agents. In young women of reproductive age, fertility-sparing procedures are performed when feasible. In cases of disease recurrence, therapy is individually tailored depending on the patient's age and general condition, the timing of relapse, and response to prior treatment
New guidelines on premature ovarian insufficiency
No full textU ovom diplomskom radu predstavljene su najnovije europske smjernice za dijagnostiku, liječenje i dugoročno praćenje prijevremene ovarijske insuficijencije (POI), koje je 2024. godine izradilo Europsko društvo za humanu reprodukciju i embriologiju (ESHRE). Prijevremena ovarijska insuficijencija je klinički entitet definiran gubitkom ovarijske funkcije prije 40. godine života, uz amenoreju ili oligomenoreju u trajanju duljem od četiri mjeseca te povišene vrijednosti folikulostimulirajućeg hormona (FSH) i sniženu koncentraciju estradiola. Etiološki spektar uključuje idiopatske, genetske, autoimune i jatrogene uzroke, pri čemu se ističe važnost pravovremene dijagnostike i informiranja žena o rizicima, osobito u kontekstu gonadotoksičnih terapija.
S obzirom na višestruke sistemske posljedice, uključujući neplodnost, osteoporozu, kardiometaboličke poremećaje, psihološke teškoće i smanjenje kvalitete života, liječenje POI-ja zahtijeva individualiziran, multidisciplinaran pristup. Hormonsko nadomjesno liječenje (HNL) preporučuje se do očekivane dobi menopauze, uz dodatne intervencije usmjerene na očuvanje kostiju, mišićne mase, psihološku stabilnost i spolno zdravlje. Iako spontana trudnoća može biti moguća u manjeg broja bolesnica, donacija oocita ostaje najučinkovitija metoda liječenja neplodnosti u ovoj populaciji.
Smjernice također prepoznaju važnost genetskog savjetovanja i edukacije članica obitelji u riziku. Cilj rada je istaknuti potrebu za sustavnim, znanstveno utemeljenim pristupom skrbi za žene s POI-jem, usmjerenim na rano prepoznavanje, pravodobno liječenje i dugoročnu podršku.This thesis presents the latest European guidelines for the diagnosis, treatment, and long-term follow-up of premature ovarian insufficiency (POI), developed in 2024 by the European Society of Human Reproduction and Embryology (ESHRE). Premature ovarian insufficiency is a clinical entity defined as the loss of ovarian function before the age of 40, characterized by amenorrhea or oligomenorrhea lasting more than four months, elevated levels of follicle-stimulating hormone (FSH), and reduced concentrations of estradiol. The etiological spectrum includes idiopathic, genetic, autoimmune, and iatrogenic causes, highlighting the importance of timely diagnosis and informing women about potential risks, particularly in the context of gonadotoxic therapies.
Given its wide-ranging systemic consequences—including infertility, osteoporosis, cardiometabolic disorders, psychological distress, and reduced quality of life—the management of POI requires an individualized, multidisciplinary approach. Hormone replacement therapy (HRT) is recommended until the average age of natural menopause, alongside additional interventions aimed at preserving bone and muscle health, psychological well-being, and sexual function. Although spontaneous conception may occur in a small proportion of patients, oocyte donation remains the most effective treatment option for infertility in this population.
The guidelines also emphasize the importance of genetic counseling and the education of at-risk female relatives. The aim of this thesis is to underscore the need for a comprehensive, evidence-based approach to the care of women with POI, focused on early recognition, timely intervention, and long-term multidisciplinary support