Veterinary medicine - Repository of PHD, master's thesis
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The relationship between tumor budding and tumor deposits and their relation to clinical-pathological parameters in patients with colorectal carcinoma
No full textU posljednje vrijeme otkrivene su nove morfološke osobine kolorektalnoga karcinoma kao važni prognostički čimbenici od kojih smo u našem istraživanju proučavali odnos tumorskoga pupanja i tumorskih depozita.
Provedeno je retrospektivno kohortno istraživanje u kojem je bilo uključeno 90 bolesnika koji su bili liječeni radikalnom kirurškom resekcijom na Klinici za kirurgiju Kliničkog bolničkog centra Sestre milosrdnice, u razdoblju između 1. siječnja 2009. i 31. prosinca 2013. godine, s patohistološki potvrđenom dijagnozom kolorektalnoga karcinoma III. stadija. Za svakog bolesnika uključenog u istraživanje analizirani su svi arhivski patohistološki preparati bojeni hemalaun-eozinom kako bi se učinio ponovni uvid u patohistološke osobitosti tumora. Ovisno o prisutnosti tumorskih depozita, patohistološki uzorci su bili podijeljeni u dvije približno jednako velike skupine i to u skupinu s prisutnim tumorskim depozitima (N=39) i u kontrolnu skupinu bez prisutnih tumorskih depozita (N=51). Prisutnost i stupanj tumorskoga pupanja dodatno su analizirani u ovim skupinama i uspoređeni s drugim kliničkim i patohistološkim značajkama.
Izmjerena prevalencija tumorskoga pupanja u kolorektalnom karcinomu III. stadija je bila neočekivano visoka i iznosila je 94.4%. Tumorski depoziti se češće pojavljuju u bolesnika s višim stupnjem tumorskoga pupanja (p=0.004). Prisutnost tumorskih depozita (p=0.01) kao i prisutnost visokog stupnja tumorskoga pupanja (p=0.001) su statistički značajno povezani s kraćim ukupnim preživljenjem bolesnika oboljelih od kolorektalnoga karcinoma III. stadija.
Rezultati istraživanja ukazuju na to da se u ranoj fazi tumorske progresije vjerojatnije radi o direktnom širenju dediferenciranih pupajućih stanica tumora u okolnu stromu, sugerirajući da bi razvoj tumorskoga pupanja i tumorskih depozita mogao biti dio istog kontinuiranog procesa. Također, rezultati dodatno naglašavaju važnost tumorskoga pupanja kao nepovoljnog prognostičkog čimbenika.Recently, some new morphological features of colorectal cancer have been discovered as significant prognostic factors. In our work, we have studied the relationship between tumor budding and tumor deposits.
The retrospective cohort study included 90 patients with pathohistologically confirmed stage III colorectal cancer who were treated with radical surgical resection at the Department of Surgery, Sestre milosrdnice University Hospital Center, in the period between January 1, 2009, and December 31, 2013. All hematoxylin and eosin (H and E)-stained slides from each patient were reviewed, and histological parameters were recorded. The samples were divided into two groups with similar sizes: a group with tumor deposits (N=39), and a control group without tumor deposits (N=51). The presence and tumor budding grade were further analyzed in these groups and compared with other clinical and histological features.
The prevalence of tumor budding in stage III CRC was unexpectedly high (94.4%). The presence of tumor deposits was significantly associated with a higher tumor budding grade (p=0.004). The presence of tumor deposits (p = 0.01) and the higher tumor budding grade (p=0.001) were statistically significantly associated with shorter survival in stage III colorectal cancer.
The results indicate that in the early stage of tumor progression, it is more likely due to the direct spread of tumor bud cells into the surrounding stroma, suggesting that the development of tumor budding and tumor deposits could be part of the same continuous process. Also, the results further emphasize the importance of tumor budding as an unfavorable prognostic factor
Estimated Pulse Wave Velocity and All-Cause and Cardiovascular Mortality in the General Population
No full textBackground: Carotid-femoral pulse wave velocity (cfPWV), acknowledged as a reliable proxy of arterial stiffness, is an independent predictor of cardiovascular (CV) events. Carotid-femoral PWV is considered the gold standard for the estimation of arterial stiffness. cfPWV is a demanding, time consuming and expensive method, and an estimated PWV (ePWV) has been suggested as an alternative method when cfPWV is not available. Our aim was to analyze the predictive role of ePWV for CV and all-cause mortality in the general population. Methods: In a stratified random sample of 1086 subjects from the general Croatian adult population (EH-UH study) (men 42.4%, average age 53 ± 16), subjects were followed for 17 years. ePWV was calculated using the following formula: ePWV = 9.587 − 0.402 × age + 4.560 × 10−3 × age2 − 2.621 × 10−5 × age2 × MBP + 3.176 × 10−3 × age × MBP − 1.832 × 10−2 × MBP. MBP= (DBP) + 0.4(SBP − DBP). Results: At the end of the follow-up period, there were 228 deaths (CV, stroke, cancer, dementia and degenerative diseases, COLD, and others 43.4%, 10.5%, 28.5%, 5.2%, 3.1%, 9.3%, respectively). In the third ePWV tercile, we observed more deaths due to CV disease than to cancer (20.5% vs. 51.04%). In a Cox regression analysis, for each increase in ePWV of 1 m/s, there was a 14% increase risk for CV death. In the subgroup of subjects with higher CV risk, we found ePWV to be a significant predictor of CV deaths (ePWV (m/s) CI 1.108; p < 0.029; HR 3.03, 95% CI 1.118–8.211). Conclusions: In subjects with high CV risk, ePWV was a significant and independent predictor of CV mortality
Implementation of Artificial Intelligence Systems in Radiology: Historical Development, Trends, and Future Perspectives
No full textZa razliku od klasičnih računalnih programa koji funkcioniraju na temelju eksplicitno definiranih instrukcija koje im programer daje, umjetna inteligencija (engl. artificial intelligence – AI) temeljena na strojnom učenju (engl. machine learning) i korištenju neuralnih mreža (engl. neural networking) može samostalno poboljšavati svoje performanse kako dobiva više podataka, odnosno ima sposobnost učenja. Takvi sustavi u radiologiji trenirani su na ogromnim skupovima podataka kako bi prepoznali patološke promjene na radiološkim snimkama uključujući tumore, frakture i druge abnormalnosti. AI sustavi u medicini dramatično mijenjaju način kako se dijagnosticiraju i liječe bolesti. Strojno učenje omogućava naprednu analizu medicinskih slika, točnije identificirajući patologiju. Ovi sustavi, nadmašujući tradicionalne metode, ubrzavaju dijagnostički proces i unapređuju kvalitetu slika, što dovodi do bržih i preciznijih dijagnoza. Primjena AI-a omogućuje i bolje praćenje pacijenata te predviđanje tijeka bolesti, doprinoseći personaliziranom pristupu liječenju. Međutim, izazovi poput integracije u zdravstvene sustave, obrade privatnosti i podataka, te etičkih pitanja predstavljaju prepreke za širu primjenu. Postoji potreba za rigoroznom validacijom AI algoritama, kao i za obukom medicinskog osoblja u korištenju ovih tehnologija. Unatoč ovim izazovima, budućnost AI-a u radiologiji izgleda obećavajuće. Očekuje se daljnji razvoj preciznijih i efikasnijih AI algoritama te njihova integracija s drugim medicinskim inovacijama. To će voditi ka boljem praćenju pacijenata i pružanju personalizirane skrbi. AI u radiologiji ima potencijal ne samo za poboljšanje kvalitete zdravstvene skrbi, već i za transformaciju načina na koji se skrb pruža, s naglaskom na pažljivu regulaciju i kontinuiranu edukaciju kako bi se maksimizirale koristi i minimizirali rizici.Unlike traditional computer programs that operate based on explicitly defined instructions given by a programmer, artificial intelligence (AI), based on machine learning and the use of neural networks, can independently improve its performance as it receives more data, exhibiting the ability to learn. Such systems in radiology are trained on vast datasets to recognize pathological changes in radiological images, including tumors, fractures, and other abnormalities. AI systems in medicine are dramatically changing as diseases are diagnosed and treated. Machine learning enables advanced analysis of medical images and more accurate identification of pathology. These systems, surpassing traditional methods, speed up the diagnostic process and enhance image quality, leading to quicker and more accurate diagnoses. The application of AI also allows for better patient monitoring and disease progression prediction, contributing to a personalized approach to treatment. However, challenges like integration into healthcare systems, data privacy, processing, and ethical issues present obstacles to broader adoption. There is a need for rigorous validation of AI algorithms, as well as training medical staff in the use of these technologies. Despite these challenges, the future of AI in radiology looks promising. Further development of more precise and efficient AI algorithms and their integration with other medical innovations are expected. This will lead to better patient monitoring and the provision of personalized care. AI in radiology has the potential not only to improve the quality of healthcare but also to transform the way care is delivered, with a focus on careful regulation and continuous education to maximize benefits and minimize risks
The influence of the simptoms of depression, anxiety and stress on the result of COMPASS-31
No full textCiljevi: Istražili smo utjecaj simptoma depresije, anksioznosti i stresa na rezultate upitnika COMPASS-31 u velikoj populaciji ispitanika upućenih na tilt table test i zdravih ispitanika (HC).
Metode: Uključeno je 959 uzastopnih ispitanika upućenih na tilt table test i 518 HC. Svi ispitanici su ispunili hrvatsku verziju upitnika Composite autonomic symptom score-31 (COMPASS-31). Simptomi depresije, anksioznosti i stresa procijenjeni su hrvatskom verzijom upitnika Depression, anxiety and stress scale-21 (DASS-21). Korigirali smo rezultat COMPASS-31 s neovisnim prediktorima kako bismo poboljšali specifičnost testa.
Rezultati: U obje skupine (ispitanici upućeni na TTT i HC) COMPASS-31 bio je viši u ispitanika sa simptomima depresije, anksioznosti i stresa (svi p < 0,001). U multivarijabilnoj linearnoj regresijskoj analizi, HC je bio negativan, dok su ženski spol, simptomi depresije, anksioznosti i stresa bili nezavisni pozitivni prediktori COMPASS-31. COMPASS-31 u zdravih ispitanika imao je medijan od 7,913, a ovu smo vrijednost koristili kao referentnu točku za analizu osjetljivosti i specifičnosti s pitanjem kako se ova vrijednost razlikuje između HC i ispitanika upućenih na TTT. COMAPSS-31 je imao visoku osjetljivost od 87% i nisku specifičnost od 50%. Kako bismo prilagodili vrijednost COMPASS-31 s parametrima koji su bili značajni u modelu multivarijabilne linearne regresije, izračunali smo novi korigirani COMAPSS-31 (cCOMPASS-31), koji je imao usporedivu osjetljivost od 77%, ali povećanu specifičnost 73%.
Zaključak: Ovo je istraživanje pokazalo da simptomi depresije, anksioznosti i stresa pogoršavaju percipiranu ozbiljnost autonomnih simptoma kod ljudi sa simptomima ortostatske intolerancije i zdrave populacije. cCOMPASS-31 je vrijedan alat koji može pomoći kliničarima u prepoznavanju prave autonomne pozadine kod osoba sa pritužbom na simptome poremećaja autonomnog živčanog sustava.Objectives: We evaluated the influence of symptoms of depression, anxiety, and stress on the results of COMPASS-31 in a large population of people referred to tilt table testing and healthy controls (HC).
Methods: 959 consecutive patients referred to tilt table testing and 518 HC were enrolled. All participants completed Composite Autonomic Symptom Score-31 (COMPASS-31). Depression, anxiety and stress symptoms were evaluated by Depression, Anxiety and Stress Scale-21 (DASS-21) questionnaire. We corrected the result of the COMPASS-31 with the independent predictors in order to improve the specificity of the test.
Results: In both groups (patients and HC) COMPASS-31 was higher in participants with depression, anxiety, and stress symptoms (all p<0.001). In a multivariable linear regression analysis, HC was negative, while female sex, symptoms of depression, anxiety, and stress were independent positive predictors of COMPASS-31. COMPASS-31 in healthy controls had a median of 7.913, and we used this value as a reference point for sensitivity and specificity analysis with a question of how this value differentiates between HC and patients. COMAPSS-31 had a high sensitivity of 87% and low specificity of 50%. In order to adjust the value of COMPASS-31 with the parameters that were significant in the multivariable linear regression model, we calculated the new corrected COMAPSS-31 (cCOMPASS-31), which had comparable sensitivity of 77%, but an increased specificity of 73%.
Conclusion: This study has shown that symptoms of depression, anxiety, and stress worsen the perceived severity of autonomic symptoms in people with symptoms of orthostatic intolerance and healthy population. cCOMPASS-31 is a valuable tool that can help clinicians in discerning the true autonomic background of patients’ complaints
The Role of Salivary Cortisone Concentration and Auditory Brainstem Response Characteristics in Assessment of the Early Occupational Noise-induced Hearing Loss Risk
No full textProcjena rizika od ranoga profesionalnog oštećenja sluha osnova je zdravstvenog nadzora osoba koje rade u buci. Kako rano oštećenje sluha nije definirano dijagnostičkim kriterijima, nove neinvazivne metode za procjenu rizika i dijagnostiku kohlearne sinaptopatije predmet su aktualnih istraživanja. Cilj ovoga istraživanja bio je utvrditi povezanost ranoga oštećenja sluha s koncentracijom kortizona u slini i s omjerom amplituda prvoga i petoga vala evociranih slušnih potencijala moždanoga debla. Sudionici su bili radnici, koji su bili izloženi buci ekvivalentne razine intenziteta ≥ 85 dB(A) na mjestu rada 1 – 2 godine (N = 50), te studenti (N = 54) kao kontrolni sudionici. Tekućinskom kromatografijom visoke djelotvornosti utvrđena je značajno veća koncentracija kortizona u slini u izloženih sudionika u odnosu na kontrolne, te pozitivna korelacija između rizika od oštećenja sluha bukom i kortizona u slini. Ispitivanjem slušnih potencijala moždanoga debla evociranih klikom razine intenziteta 80 ili 90 dB, nije nađena korelacija između rizika od ranoga oštećenja sluha bukom i omjera amplituda prvoga i petoga vala. Rizik od ranoga profesionalnog oštećenja sluha moguće je djelomično procijeniti pomoću amplitude prvoga vala slušnih potencijala moždanoga debla evociranih klikom razine intenziteta 80 dB, koncentracije kortizona u slini, dobi i spola u mladih odraslih osoba.Assessment of the early occupational noise-induced hearing loss risk is fundamental for health surveillance of people who work in noise. As early hearing loss is not well-defined diagnosis, novel non-invasive diagnostic methods are subjects of the current studies of the cochlear synaptopathy. The aim of this research was to determine the correlation between early hearing loss and: salivary cortisone level and the amplitude ratio of the first and fifth wave of evoked auditory brainstem response. The participants were workers, who were exposed to occupational noise ≥ 85 dB(A) for 1 – 2 years (N = 50), and students (N = 54) as controls. High-performance liquid chromatography revealed a significantly higher salivary cortisone level in exposed participants compared to the controls, and a positive correlation between the risk and salivary cortisone level. By examining auditory brainstem response evoked by a click at 80 or 90 dB, no correlation was found between the risk and the amplitude ratio of the first and fifth wave. Early occupational noise-induced hearing loss risk can be partially predicted by salivary cortisone level, amplitude of the first wave of auditory brainstem response evoked by a click at 80 dB, age, and sex in young adults
Tumor budding and microsatellite instability in patients with sporadic colon and rectal cancer stage II
No full textBolesnici s kolorektalnim karcinomom stadija II predstavljaju skup biološki dosta različitih tumora različitog preživljenja unatoč homogenosti klasifikacije stadija II. Razvojem molekularne biologije i histopatologije javlja se potreba bolje kategorizacije s ciljem prepoznavanja karcinoma s većim rizikom diseminacije.
U provedenoj studiji retrospektivno je analizirano 89 bolesnika s kolorektalnim karcinomom stadija II gdje su uz standardne sastavnice patohistološkog nalaza za kolorektalni karcinom određivani mikrosatelitna nestabilnost i tumorsko pupanje na standardnim hemalaun-eozinskim preparatima. Dobiveni podaci korišteni su za analizu preživljenja, i to odvojeno za endoskopske biopsije i resektate, uporabom algoritma rekurzivnoga particioniranja zvanog rpart.
Iz podataka endoskopske biopsije, rpart algoritam smatra da najveći informacijski značaj imaju tumorsko pupanje, vaskularna invazija te dob bolesnika. Rpart algoritam iz podataka resektata određuje da najveći informacijski značaj imaju broj pregledanih limfnih čvorova, tumorsko pupanje te vaskularna invazija. U ovom radu rpart algoritam nije prepoznao mikrosatelitnu nestabilnost kao prognostički čimbenik na endoskopskoj biopsiji ni resektatu.
Važno je istaći da uz biološke karakteristike tumora osnovnu prognostičku značajku kolorektalnog karcinoma stadija II čini kvaliteta izvedenog kirurškog zahvata te samog patohistološkog nalaza koja se očituje prvenstveno u broju pregledanih limfnih čvorova. Rezultati ovog rada upućuju na to da uz mikrosatelitnu nestabilnost tumorsko pupanje treba postati sastavni dio patohistološkog nalaza kolorektalnog karcinoma.Colorectal cancer stage II represent a set of biologically quite different tumors with different survival despite the homogeneity of the stage II classification.
The study retrospectively analyzed 89 patients with colorectal cancer stage II, where in addition to the standard components of the pathohistological findings for colorectal cancer, MSI and tumor budding were determined. The data obtained were used for survival analysis, for endoscopic biopsies and resects.
From endoscopic biopsy data, the rpart algorithm considers that tumor budding, vascular invasion, and age of patients are of the greatest informational importance. The rpart algorithm from the resect data determines that the number of examined
lymph nodes, tumor budding and vascular invasion are of the greatest informational importance. In this paper, the rpart algorithm did not recognize microsatellite instability as a prognostic factor.
It is important to point out that in addition to the biological characteristics of the tumor, the basic prognostic feature of stage II colorectal cancer is the quality of the performed surgery and the pathohistological findings, manifested primarily in the number of examined lymph nodes. The results suggest that in addition to microsatellite instability, tumor budding should become an integral part of the pathohistological findings of colorectal cancer
Noncardiogenic cardiac arrest
No full textSrčani zastoj uzrokovan je izostankom odgovarajuće mehaničke aktivnosti srca, čime dolazi do zastoja cirkulacije i neizbježne smrti pacijenta ukoliko se ne pristupi reanimaciji. Iako većinom kardiogene etiologije, srčani zastoj može biti i nekardiogenog porijekla. Nekardiogeni uzroci većinom su reverzibilni, što znači da njihovo pravodobno prepoznavanje i liječenje dovodi do povratka spontane cirkulacije i prekida srčanog zastoja pacijenta. Smjernice Europskog vijeća za reanimatologiju u svojem ALS (engl. Advanced Life Support) algoritmu preporučaju korištenje mnemotehnike „4H i 4T“ za prepoznavanje nekardiogenih uzroka, gdje četiri H označavaju hipoksiju, hipovolemiju, hipokalemiju i hiperkalemiju te hipotermiju i hipertermiju. Četiri T označavaju tamponadu, tenzijski pneumotoraks, trombozu, tj. plućnu emboliju i trombozu koronarne arterije te toksine. Hipoksija je najčešći uzrok srčanog zastoja u pedijatrijskoj populaciji. Nastaje većinom zbog asfiksije, a prethodi mu predarestni period progresivnog pogoršanja kardiopulmonalne funkcije. Srčani zastoj zbog hipovolemije viđa se uglavnom u politraumatiziranih pacijenata zbog velikog gubitka krvi. Ključ liječenja je zaustavljanje krvarenja i brza nadoknada volumena otopinama i krvnim pripravcima. Hiperkalemija i hipokalemija najčešći su elektrolitski poremećaji koji uzrokuju srčani zastoj, a česti su u pacijenata s oštećenom bubrežnom funkcijom. Hipotermija nije toliko česta, a pacijenti sa srčanim zastojem uslijed hipotermije imaju vrlo dobro preživljenje i neurološke ishode budući da hipotermija djeluje protektivno na mozak. Zastoj srca uslijed hipertermije također se ne događa često, no za anesteziologa je važno pažnju obratiti na sklonost pacijenta malignoj hipertermiji, hipermetaboličkoj reakciji skeletnih mišića na primjenu inhalacijskih anestetika i sukcinilkolina. Tamponada srca i tenzijski pneumotoraks događaju se uglavnom tijekom ozljeda i trauma, a srčani zastoj uzrokuju mehaničkom opstrukcijom protoka krvi pa su standardni reanimacijski postupci bez liječenja ovih uzroka često uzaludni. Plućna embolija i tromboza koronarne arterije najčešći su uzroci srčanog zastoja, a zahtijevaju hitan transport pacijenta u bolnicu gdje je moguće liječenje. Srčani zastoj uzrokovan toksinima nastaje zbog direktnog toksičnog djelovanja na srce ili poremećaja elektrolita, a najčešće je uzrokovan predoziranjem opioidima, benzodiazepinima u kombinaciji s alkoholom i tricikličkim antidepresivima.Cardiac arrest is caused by the absence of appropriate mechanical activity of the heart, resulting in a cessation of circulation and inevitable death if resuscitation is not initiated. Although it is mostly of cardiogenic etiology, cardiac arrest can also be noncardiogenic. Noncardiogenic causes are mostly reversible, meaning that timely recognition and treatment can lead to the return of spontaneous circulation and cessation of cardiac arrest. The European Resuscitation Council guidelines in their ALS (Advanced Life Support) algorithm recommend the use of the mnemonic "4H and 4T" to recognize noncardiogenic causes, where the four H's stand for hypoxia, hypovolemia, hypo- and hyperkalemia, and hypo- and hyperthermia. The four T's are tamponade, tension pneumothorax, thrombosis, i.e., pulmonary embolism and coronary artery thrombosis, and toxins. Hypoxia is the most common cause of cardiac arrest in the pediatric population. It mostly occurs due to asphyxia and is preceded by a pre-arrest period of progressive worsening of cardiopulmonary function. Cardiac arrest due to hypovolemia is mostly seen in trauma patients due to significant blood loss. The key to treatment is stopping the bleeding and quickly replacing volume with solutions and blood products. Hyperkalemia and hypokalemia are the most common electrolyte disturbances causing cardiac arrest and are frequent in patients with impaired renal function. Hypothermia is not as common, but patients with cardiac arrest due to hypothermia have very good survival and neurological outcomes since hypothermia has a protective effect on the brain. Hyperthermia is also uncommon, but it is important for anesthesiologists to pay attention to the patient's susceptibility to malignant hyperthermia, a hypermetabolic reaction of skeletal muscles to inhalation anesthetics and succinylcholine. Cardiac tamponade and tension pneumothorax mostly occur during injuries and traumas, causing cardiac arrest through mechanical obstruction of blood flow, so standard resuscitation procedures without treating these causes are often futile. Pulmonary embolism and coronary artery thrombosis are the most common causes of cardiac arrest and require urgent transport of the patient to a hospital where treatment is possible. Cardiac arrest caused by toxins occurs due to direct toxic effects on the heart or electrolyte disturbances and is most commonly caused by overdose of opioids, benzodiazepines in combination with alcohol, and tricyclic antidepressants
Otoplasty
No full textOtoplastika je kirurška procedura usmjerena na korekciju kongenitalnih ili stečenih deformiteta
ušnih školjki, s ciljem poboljšanja estetskog izgleda i funkcionalnosti uha. Odstojeće uši
zahvaćaju otprilike 5% populacije i najčešći su razlog za otoplastiku. Spomenuta deformacija
izaziva značajan emocionalni stres, osobito kod djece, te može dovesti do poteškoća u
socijalizaciji i do manjka samopouzdanja. U otoplastici postoje brojni kirurški pristupi kao što su
Mustarde tehnika, Furnasova tehnika, Converse tehnika i mnoge druge. Izbor kirurške metode
ovisi o anatomskoj strukturi uške svakog pojedinog pacijenta prilikom čega se moraju uvažiti
njegovi zahtjevi u okviru mogućega. Svaka kirurška tehnika ima svoje prednosti i nedostatke koji
će biti važan čimbenik u odabiru same metode otoplastike. Istraživanja su pokazala da pravilno
izvedena otoplastika može značajno utjecati na izgled i samopouzdanje pacijenata što za
posljedicu ima smanjeni psihološki stres i bolju društvenu integraciju. Relativno rijetke, no
moguće, komplikacije mogu uključivati hematome, infekcije, keloide i nezadovoljavajuće estetske
rezultate. Važne mjere za umanjivanje rizika uključuju detaljnu preoperativnu obradu pacijenta,
optimalnu kiruršku tehniku i postoperativnu njegu. Nekirurške metode otoplastike i minimalno
invazivne metode smanjuju učestalost komplikacija i dovode do boljih rezultata operativnog
zahvata i kraćeg postoperativnog oporavka. Unatoč estetskim i funkcionalnim benefitima koji
proizlaze iz otoplastike, treba naglasiti da vrijednost pojedinca nije definirana nijednim fizičkim
nedostatkom. Pred roditeljima djece koja imaju deformitet ušiju je izazovna i teška odluka o tome
hoće li podvrgnuti vlastito dijete operativnom zahvatu ili će ga pokušati pripremiti na moguće
društvene osude i neprihvaćanje. Svakako je cilj otoplastike pokušati poporaviti kvalitetu života
pacijenata, ali isto tako je od velike važnosti važno promovirati društvenu inkluziju i prihvaćanje
okoline. Otoplastika ima značajan potencijal za poboljšanje kvalitete života pacijenata uz
minimalan rizik od komplikacija. Za postizanje još boljih rezultata otoplastike, daljna istraživanja i
napredak medicinske tehnologije su od krucijalne važnosti.Otoplasty is a surgical procedure aimed at correcting congenital or acquired deformities of the
auricles, to improve the aesthetic appearance and functionality of the ear. Protruding ears affect
approximately 5% of the population and are the most common reason for otoplasty. The
aforementioned deformity causes significant emotional stress, especially in children, and can
lead to difficulties in socialization and a lack of self-confidence. In otoplasty, there are numerous
surgical approaches such as the Mustarde, Furnas, Converse, and many others. The choice of
surgical method depends on the anatomical structure of each patient's ear, during which his
requirements must be respected as much as possible. Each surgical technique has its
advantages and disadvantages, which will be an important factor in choosing the otoplasty
method itself. Research has shown that properly performed otoplasty can significantly affect the
appearance and self-confidence of patients, resulting in reduced psychological stress and better
social integration. Relatively rare, but possible, complications may include hematomas,
infections, keloids, and unsatisfactory aesthetic results. Important measures to minimize risk
include detailed preoperative patient workup, optimal surgical technique, and postoperative care.
Non-surgical methods of otoplasty and minimally invasive methods reduce the frequency of
complications and lead to better results of the operation and shorter postoperative recovery.
Despite the aesthetic and functional benefits resulting from otoplasty, it should be emphasized
that the value of an individual is not defined by any physical deficiency. Parents of children with
ear deformities face a challenging decision about whether to subject their child to surgery or
whether to try to prepare him for possible social condemnation and non-acceptance. The goal of
otoplasty is to try to improve the quality of life of patients. Still, it is also of great importance to
promote social inclusion and acceptance of the environment. Otoplasty has a significant potential
to improve the quality of life of patients with a minimal risk of complications. To achieve even
better results of otoplasty, further research and advances in medical technology are of crucial
importance
Uterine Artery Embolization for Uterine Fibroids: Predictive MRI Features of Volumetric Response
No full textCilj ovog istraživanja bio je istražiti utječu li početni volumen mioma, FIGO klasifikacija mioma, omjer intenziteta signala na T2 snimkama magnetne rezonancije i broj mioma na ishod embolizacije uterinih arterija te prikazati 6-godišnje rezultate iz jednog kliničkog centra. Retrospektivno je pregledana medicinska dokumentacija, procedure embolizacije i snimke MR-a 74 pacijentice koje su bile podvrgnute proceduri embolizacije arterije uterine u KBC Sestre Milosrdnice između 2017. i 2023. godine. Rezultati su pokazali negativnu povezanost između početnog volumena mioma i redukcije volumena mioma, pri čemu su veći miomi pokazali manju redukciju volumena (p < 0.001). Pronađena je statistički značajna razlika između redukcije volumena mioma između pojedinih skupina FIGO klasifikacije. Submukozni miomi pokazali su najbolju redukciju volumena sa statistički značajnom razlikom prema hibridnim mioma i subseroznim miomima. Nije pronađena statistički značajna razlika u redukciji volumena između hibridnih i subseroznih mioma. U istraživanju nije pronađena povezanost između omjera intenziteta signala na T2 snimkama i broja mioma na ishod postupka. Ovo istraživanje ukazuje da su submukozni miomi i miomi manjeg početnog volumena povezani s boljom redukcijom volumena i mogu biti prognostički čimbenik za uspješnost embolizacije uterine arterije. Zaključno, ovo istraživanje potvrđuje da je embolizacija uterine arterije sigurna i učinkovita procedura za liječenje mioma maternice.The aim of this study was to investigate whether initial fibroid volume, FIGO classification, signal intensity ratio (SIR) on T2-weighted magnetic resonance images (MRI) and the number of fibroids affect the outcome of Uterine Artery Embolization (UAE) as well as report of 6-year single-center experience with UAE procedures. Medical history, UAE and MRI examinations from 75 patients from the Sestre Milosrdnice University Hospital Centre who underwent UAE between 2017 and 2023 were reviewed retrospectively. Results showed a negative correlation between baseline fibroid volume and volume reduction of the fibroid, with larger fibroids showing smaller volume reduction (p < 0.001). There was a statistically significant difference between FIGO classification groups and volume reduction of the fibroids. Submucosal fibroids showed the best volume reduction compared to hybrid fibroids and subserosal fibroids. There was no significant difference between hybrid and subserosal fibroids in volume reduction. We found no correlation between MRI SIR and the number of fibroids on UAE procedure outcomes. The present study suggests that submucosal fibroids and smaller baseline fibroid volume could be related to greater volume reduction and may be a useful prognostic factor for UAE procedure success. In conclusion, this study confirms that UAE is a safe and effective procedure for the treatment of uterine fibroids
Continuous tissue glucose monitoring in patients in a state of shock
No full textCirkulacijski šok životno je ugrožavajuće stanje obilježeno smanjenim protokom krvi, kisika i hranidbenih tvari do tkiva i organa te smanjenim otplavljivanjem razgradnih metaboličkih produkata iz perifernih tkiva. Prema etiologiji, cirkulacijski šok dijeli se u kardiogeni, hipovolemijski, distributivni i opstruktivni šok. Tijekom šoka događaju se različiti patofiziološki procesi u organizmu koji katkad rezultiraju poremećajem metabolizma glukoze. Poremećaji metabolizma glukoze poput različitih oblika šećerne bolesti, predijabetesa, stresne hiperglikemije i hipoglikemije mogu povećati rizik od smrtnog ishoda u kritično oboljelih pacijenata. U posljednjih nekoliko godina razvio se uređaj za kontinuirano mjerenje glukoze koji se može ugraditi pacijentima oboljelim od šećerne bolesti. Zbog poboljšanja praćenja varijabilnosti u vrijednosti glukoze kod pacijenata sa šećernom bolešću u stvarnom vremenu, uređaj za kontinuirano mjerenje glukoze predstavlja budućnost praćenja promjena glukoze kod kritično oboljelih pacijenata nakon šoka. Njegova bi primjena omogućila praćenje vrijednosti glukoze svake minute te precizniju primjenu terapije radi očuvanja urednih vrijednosti glukoze. Njegovom primjenom smanjile bi se hipoglikemijske i hiperglikemijske epizode kod pacijenata koje koreliraju s lošijim ishodom. Iako još uvijek ne postoje točno određene smjernice koje definiraju raspon glukoze u tkivima kod ove subpopulacije pacijenata, uređaj za kontinuirano mjerenje glukoze omogućio bi individualizirani pristup održavanja razine glukoze svakog pacijenta.Circulatory shock is a life-threatening condition characterized by reduced blood flow, lowered oxygen and nutrients supply to peripheral tissues and a decreased removal of metabolic products from peripheral tissues. According to its etiology, circulatory shock is classified into cardiogenic, hypovolemic, distributive and obstructive shock. During shock, various pathophysiological processes occur in the body, sometimes resulting in glucose metabolism disorders. Glucose metabolism disorders, such as different forms of diabetes mellitus, prediabetes, stress-induced hyperglycemia and hypoglycemia can increase the risk of mortality in critically ill patients. In recent years, a continuous glucose monitoring device has been developed that can be implanted in patients with diabetes. Due to its improvement in tracking glucose variability in real-time for patients with diabetes, the continuous glucose monitoring device represents the future of monitoring glucose changes in critically ill patients after shock. Its application would allow minute-by-minute monitoring of glucose levels and more precise therapy to maintain normal glucose values. Its use would reduce hypoglycemic and hyperglycemic episodes in patients, which correlate with poorer outcomes. Although there are no precisely defined guidelines defining the range of glucose levels in tissues for this subpopulation of patients, the continuous glucose monitoring device would enable an individualized approach to maintaining each patient's glucose levels