1,720,993 research outputs found
Infekcija, upala i antibiotici
No full textPatološki mikroorganizmi mogu na čovjeku izazvati sljedeće posljedice: privremenu kolonizaciju, trajnu kolonizaciju, izazvati bolest (infekciju) organizma. Pojam infekcije često se koristi za objedinjavanje pojmova kolonizacije i bolesti što nije opravdano. Postoje tri osnovne obrane od invazije mikroorganizama: prirodna obrana (koža, sluznica, želučana kiselina, žuč itd.), nespecifična imunološka reakcija prirodnih antigena (temperatura, neutrofili, makrofagi, interferon, prirodne stanice ubojice), specifična antigenska obrana koja ciljano djeluje na uzročnika (antitijela, T-stanice). Kirurškim infekcijama nazivamo one koje treba kirurški liječiti ili one koje su nastale kao posljedica kirurškoga postupka. Razvoj infekcije ovisi o tri čimbenika: količini unesenih mikroorganizama, virulenciji uzročnika, općem stanju organizma (imuni sustay, dob, prokrvljenost tkiva, kirurški postupak za operirane bolesnike itd.)
Effect of mitosis in melanoma on the incidence of metastasis in the sentinel lymph node in melanoma thinner than 2 mm
Get PDFCilj rada je ispitati jesu li mitoze vjerodostojan pokazatelj metastaza u sentinel limfnom čvoru. U istraživanje je uključeno 120 bolesnika s melanomom. Nakon rutinske predoperacijske obrade bolesnika (kompletna krvna slika, koagulogram, biokemijski nalazi, elektrokardiogram, telerendgenogram srca i pluća), limfoscintigrafski se određuje lokalizacija sentinel limfnog čvora. Za svakog bolesnika obrađeni su sljedeći podaci: prisutnost ulceracije, debljina melanoma po Breslowu, tip rasta, vaskularna invazija, patohistološki nalaz jednog ili više sentinel limfnih čvorova (prisutnost metastaza). Od ukupno 120 bolesnika, 59 je muškaraca i 61 žena. Nije bilo statistički značajne razlike između dobi bolesnica i bolesnika (t-test p=0,53). Lokalizacija melanoma u 120 bolesnika uključenih u istraživanje najčešće je uključivala trup i to u 61 bolesnika (50,8%).Najčešće zastupljen melanom je površinsko šireći melanom (SSM) u 95 bolesnika (79,2%). Ulceracija je prisutna u 40 bolesnika (33,3%), regresija melanoma je zamijećena u 2 bolesnika (1,7%), vaskularna invazija u 7 bolesnika (5,8%), limfocitna infiltracija tumora u 14 bolesnika (11,7%), a više od jedne mitoze po kvadratnom milimetru u 3 bolesnika (2,5%). U 27 bolesnika (22,5%) u sentinel limfnom čvoru nalazila se metastaza. U 11 bolesnica i 16 bolesnika sentinel limfni čvor bio je metastatski promijenjen. Lokalizacija melanoma između spolova statistički se značajno razlikuje (p=0,014), te je u žena češća na udovima (28/61, 45,9%), a u muškaraca na trupu (36/59, 60,3%). Dob, spol, lokalizacija melanoma nemaju prognostičku vrijednost prisutnosti metastaze u sentinel limfnome čvoru. Mitoze nisu statistički značajan prognostički čimbenik. Debljina melanoma (p=0,00001) i ulceracija (p=0,007) statistički su značajni prognostički pokazatelji metastaza u sentinel limfnome čvoru što je analizirano univarijatnom logističkom regresijom.The aim of the study was to examine if mitosis was a significant prognostic factor of positive sentinel lymph node. This study included 120 patients with melanoma. After a routine pre-surgery treatment of the patients (complete blood count, coagulogram, biochemical findings, electrocardiogram, x-ray of the heart and lungs), lympho-scintigraphy determines localization of sentinel lymph node. For each patient the following data were analyzed: the presence of ulceration, Breslow thickness melanoma, a type of growth, vascular invasion, histopathological finding of one or more sentinel lymph nodes (presence of metastases). There were 59 men and 61 women out of the 120 patients. No statistically significant differences between patients' age and patients were determined (t-test, p = 0.53). The most common localization of melanoma of the 120 patients was on the body of 61 patients (50.8%). Most frequent melanoma is superficial spreading melanoma (SSM) in 95 patients (79.2%). Ulceration was present in 40 patients (33.3%), regression of melanoma was observed in 2 patients (1.7%), vascular invasion in 7 patients (5.8%), lymphocytic infiltration of the tumor in 14 patients (11.7%), and more than one mitosis per square millimeter in 3 patients (2.5%). In 27 patients (22.5%) of sentinel lymph node metastasis was located. In 11 out of 16 patients with sentinel lymph node metastasis was changed. Localization of melanoma between the sexes was statistically significant (p = 0.014), and is more common in women on the limbs (28/61, 45.9%), and in men on the body (36/59, 60.3%). Age, gender, localization of melanoma have prognostic value of the presence of metastases in the sentinel lymph node. Mitosis was not statistically significant prognostic factor. The thickness of the melanomas (p = 0.00001) and ulceration (p = 0.007) were statistically significant prognostic indicators of metastasis in sentinel lymph node as analyzed univariate logistic regression
Risks associated with alloplastic material use in primary breast reconstruction
Get PDFUvod i ciljevi: Upotreba aloplastičnih materijala za pokrivanje defekta donjeg pola dojke kod primarne rekonstrukcije pomoću implantata postala je sve raširenija alternativa kompletnoj rekonstrukciji autolognim tkivom. Obje vrste rekonstruktivnih zahvata nose rizik određenih ranih i kasnih komplikacija. Cilj ove studije bio je usporediti sigurnost primjene odnosno učestalost komplikacija između bolesnica kod kojih je primarna rekonstrukcija izvedena s potpunim pokrivanjem implantata autolognim tkivom i onih kod kojih su u rekonstrukciji korišteni aloplastični materijali. ----- Bolesnice i metodologija: Retrospektivna studija uključila je bolesnice operirane u razdoblju od 2012. do 2016. godine na Klinici za plastičnu, rekonstrukcijsku i estetsku kirurgiju Kliničke bolnice Dubrava, kod kojih je nakon mastektomije učinjena primarna rekonstrukcija dojke implantatom. Uključeno je ukupno 98 bolesnica s primarnom rekonstrukcijom 115 dojki, a kod 21 bolesnice, odnosno rekonstrukcije 26 dojki, korišten je aloplastični materijal. Uspoređena je među skupinama učestalost ranih i kasnih komplikacija, te potreba za kirurškom revizijom i ekstrakcijom proteze. ----- Rezultati: Ukupna učestalost ranih komplikacija iznosila je 44/115 (38.3%), od čega 9/26 (34.6%) u skupini s korištenjem aloplastičnih materijala i 35/89 (39.3%) u skupini s rekonstrukcijom autolognim tkivom. Učestalost pojedinačnih komplikacija također se nije značajno razlikovala među skupinama (serom 11.54% vs. 16.85%, hematom 3.85% vs. 3.37%, infekcija 11.54% vs. 11.24%, apsces 0 vs. 2.25%, MAK nekroza 0 vs. 3.37%, dehiscencija rane 0 vs. 1.12%, nekroza kožnog režnja 3.85% vs. 0%, protruzija implantata 3.85% vs. 1.12%). Učestalost kasnih komplikacija bila je učestalija u skupini s rekonstrukcijom autolognim tkivom: kontraktura fibrozne kapsule 14.6% vs. 3.8%, a ruptura implantata 3.37% vs. 0%. Potreba za kirurškom revizijom, odnosno ekstrakcijom implantata, bila je podjednaka u obje skupine (14.6% vs. 11.5%). ----- Zaključak: Primjena alopastičnih materijala kod rekonstrukcije donjeg pola dojke predstavlja sigurnu terapijsku opciju, sa stopama komplikacija koje su usporedive ili manje u odnosu na rekonstrukciju autolognim tkivom.Introduction and aims: Alloplastic material use in primary breast reconstruction has become a widely-accepted alternative to traditional complete submuscular coverage. Both types of reconstruction procedures confer a certain risk for early and late complications. The aim of our study was to compare safety of these procedure types by analysis of complication rates. ----- Patients and methods: Retrospective study included patients operated in the period from 2012 to 2016 at Department of plastic, reconstructive and aesthetic surgery, University hospital Dubrava, who underwent implant-based primary breast reconstruction after mastectomy. We included 98 patients with primary reconstruction of 115 breasts, including 21 patients (26 breasts) with alloplastic material use. The groups were compared with regard to early and late complications, as well as need for surgical revision and implant removal. ----- Results: Early complications rate in our cohort was 44/115 (38.3%), including 9/26 (34.6%) in group with alloplastic material use and 35/89 (39.3%) in group with complete submuscular coverage. Frequency of specific complications was also similar between groups (seroma 11.54% vs. 16.85%, hematoma 3.85% vs. 3.37%, infection 11.54% vs. 11.24%, abscess 0 vs. 2.25%, NAC necrosis 0 vs. 3.37%, wound dehiscence 0 vs. 1.12%, flap necrosis 3.85% vs. 0%, implant protrusion 3.85% vs. 1.12%). Late complications were more frequent in traditional complete submuscular coverage group: capsular contraction 14.6% vs. 3.8%, and implant rupture 3.37% vs. 0%. Surgical revision and implant extraction frequency was similar in both groups (14.6% vs. 11.5%). ----- Conclusion: Alloplastic material use in primary breast reconstruction represents a safe therapeutic option, with complication rates that are similar or even lower when compared to reconstruction with traditional complete submuscular coverage
Changes in parabens concentration in women with breast cancer in upper lateral quadrant of the breast
No full textSvrha rada: Utvrditi postoji li statistički značajna razlika u koncentraciji parabena u urinu, krvi i tkivu dojke između zdravih žena i žena sa zloćudnim tumorima dojke. Utvrditi učinak mješavine endokrinih disruptora, parabena i plastičnih nanočestica na proliferacijsku aktivnost humanih stanica raka dojke. -----
Metode: U istraživanje su uključene 72 ispitanice, 49 žena sa zloćudnim tumorom dojke i 23 zdrave žene. Analizirana su sociodemografska obilježja, antropometrijske mjere, čimbenici rizika za razvoj raka, životne navike i učestalost primjene kozmetičkih proizvoda. Rezultati se uspoređuju s koncentracijama parabena iz humanih uzoraka. Sinergijski učinak koktela parabena i nanoplastike procjenjuje se na temelju proliferacije MDA-MB 231 te MCF-7 stanične linije raka dojke. -----
Rezultat: S razinom pouzdanosti od 95% dokazano je da žene sa zloćudnim tumorima dojke u GLK-u imaju značajno veću koncentraciju parabena u plazmi. Statistički se nije našla značajna razlika između koncentracija parabena u urinu. Bolesne žene, iako imaju veću koncentraciju svih parabena u plazmi, imaju manju koncentraciju u tkivu od zdravih. Bolesne žene starije životne dobi, manje su fizički aktivne, imaju veći BMI te veće i agresivnije tumore. -----
Zaključak: Žene sa zloćudnim tumorom dojke starije životne dobi imaju više nerazgrađenih parabena koji cirkuliraju krvi (plazmom) te mogu utjecati na proliferaciju estrogen osjetljivih stanica dojke što dovodi do povećanog rizika za razvoj hormonski ovisnog raka dojke. Parabeni sinergijski potaknuti („učinak mješavine” ili „učinak koktela”) prisutnošću plastičnih nanočestica pojačavaju proliferacijsku aktivnost stanica raka dojke osjetljivih na estrogene.Objective. Determine significant difference compering urine, plasma and breast tissue parabens concentrations between healthy and breast cancer woman. Endocrine disruptors chemical cocktails of parabens and plastic nanoparticles is evaluated by proliferative activity of breast cancer. -----
Methods. This study includes 72 patients, 49 breast cancer and 23 healthy women. Sociodemographic, anthropometric measures, cancer risk factors, lifestyle, and frequency of cosmetic use is compared with paraben concentrations in human samples. Study evaluates effects of mixture of plastic and parabens on proliferation of breast cancer lines: MDA-MB 231 and MCF-7 cells. -----
Results: Women with breast cancer in upper lateral quadrant have higher plasma paraben concentration. No statistical differences are found between urine concentration. Breast cancer women with higher plasma concentration have less parabens in breast tissue then healthy women. Less active women with breast cancer have more weight and larger, aggressive cancer. ------
Conclusion. Women with breast cancer located in upper lateral quadrant have higher plasma parabens levels and similar concentrations in urine compared to healthy women. Parabens in synergistic with plastic nanoparticles increased proliferation of estrogen-sensitive breast cancer cells
Motivation of Women and Attitude of Surgeon to Immediate Breast Reconstruction after Mastectomy for Breast Cancer
Get PDFSuvremeni pristup u lijeĉenju raka dojke ukljuĉuje mastektomiju i primarnu rekonstrukciju dojke (rekonstrukcija u istom aktu s mastektomijom). Cilj istraţivanja je utvrditi sociodemografske i kliniĉke ĉimbenike koji utjeĉu na odluku ţena u odabiru primarne rekonstrukcije dojke i istraţiti stav kirurga obzirom na subspecijalnost prema primarnoj rekonstrukciji dojke.
Provedeno je monocentrično, prospektivno istraživanje u razdoblju od siječnja 2012. do listopada 2013. godine u žena oboljelih od raka dojke (n=100; veličina uzorka određena je analizom snage uzorka) obzirom na utjecaj sociodemografskih i kliničkih faktora na odluku o primarnoj rekonstrukciji dojke nakon mastektomije i multicentrična prospektivna studija stava kirurga (n=21) koji se bave liječenjem raka dojke obzirom na primarnu rekonstrukciju dojke nakon mastektomije. Učinjena je komparativna analiza stavova kirurga i ispitanica, te komparativna analiza trenda istraživanih varijabli usporedbom sa sličnim istraživanjem provedenim 2005.- 2006. godine. Metode korištene u ovom istraživanju ukljuĉuju upitnike, intervju i pregled medicinske dokumentacije. Čimbenici koji predviđaju pristanak na primarnu rekonstrukciju dojke su dob (p=0,0001), mjesto rođenja (p=001), obrazovanje (p=0,007), radni status (p=0,0002), bračni status (p=0,009) i iskustvo raka dojke u obitelji. Razlozi zbog kojih se odbija primarna rekonstrukcija su strah povrata bolesti i dob. Istraživani stavovi u odnosu na socio-demografske i kliničke varijable nisu značajnije promijenjeni u razdoblju 2005.-2006. te 2012.-2013. godine. Svi kirurzi koji operiraju dojku radi malignih bolesti ne rekonstruiraju dojku. Primarnu rekonstrukciju rade samo plastiĉni kirurzi. Razlog zbog kojeg kirurzi ne rade primarnu rekonstrukciju je onkološka (ne)sigurnost.
Socio-demografski i klinički čimbenici značajni su i stabilni prediktori stava žena prema primarnoj rekonstrukciji dojke. Kirurška subspecijalnost prediktor je stava kirurga prema primarnoj rekonstrukciji dojke nakon mastektomije.Aim of the study. Modern approach to the treatment of breast cancer includes mastectomy and immediate breast reconstruction (single act breast reconstruction following mastectomy). The aim of the research was to determine the socio-demographic and clinical factors that influence the decision of women in the selection of immediate breast reconstruction and explore the viewpoint of surgeons for immediate breast reconstruction, in respect to their subspecialty.
Methods. A prospective monocentric study was conducted among women with breast cancer (Jan 2012 - Oct 2013; n=100; sample size was determined by power analysis) to determine socio-demographic and clinical factors in the decision-making process of the patients. Also, a multicentre prospective study was conducted regarding the opinions of surgeons (n=21) involved in the treatment of breast cancer, with emphasis on immediate breast reconstruction. Comparative analysis of both the opinions of surgeons and patients was performed and the results compared to a similar research conducted in 2005 - 2006. Methods included questionnaires, interviews and medical documentation reviews.
Results. Variables which determined the consent to immediate breast reconstruction were age (p=0,0001), place of birth (p=0,01), education (p=0,007), employment status (p=0,0002), marital status (p=0,009) and family history of breast cancer. Reasons for the rejection of immediate breast reconstruction were fear of recurrence and patient’s advanced age. Researched attitudes towards immediate breast reconstruction regarding sociodemographic and clinical variables in the decision-making process did not change significantly between the surveys in 2005-2006 and 2012-2013. All surgeons who perform mastectomies for breast cancer do not reconstruct the breast. Immediate breast reconstructions are only performed by plastic and reconstructive surgeons. The main reason why most surgeons do not perform immediate breast reconstructions is oncologic (un)certainty.
Conclusion. Sociodemographic and clinical characteristics of women are significant and stable predictors of attitude toward immediate breast reconstruction after mastectomy. Surgical subspecialty is a strong predictor of one’s attitude toward immediate breast reconstruction following mastectomy
Seventh version of American Joint Committee on Cancer classification for melanoma
No full textPosljednja revizija klasifikacije kožnog melanoma objavljena je nakon obrade baze podataka Američkog komiteta za rak (American Joint Committee on Cancer - AJCC). Preporuke klasifikacije melanoma izvedene su nakon multivarijantne statističke obrade podataka 30.946 bolesnika stadija melanoma I., II. i III. te 7972 bolesnika IV. stadija. Rezultati i nove definicije obuhvaćaju sljedeće: mitotski indeks zamjenjuje dubinu invazije melanoma kao kriterij za definiciju melanoma T1b, svi bolesnici s mikroskopskim metastazama u limfnim čvorovima klasificiraju se kao III. stadij bolesti, dok se i metastazeRecent revision of the staging system for cutaneous melanoma has been published after an analysis of data from an expanded American Joint Committee on Cancer (AJCC) Melanoma Staging Database. Staging recommendations were made after a multivariate analysis of 30,946 patients with melanoma stages I, II and III and 7,972 patients with stage IV melanoma. Based on the results, new definitions have been suggested as follows: mitotic rate replaces the level of invasion as a criterion for defining T1b melanomas; all patients with microscopic nodal metastases are classified as stage III; metastase
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Plastično-rekonstrukcijska i estetska kirurgija: Reumatoidni artritis šake
No full textReumatoidni artritis je kronična sistemska, autoimuna bolest nepoznate etiologije koja se očituje simetričnim upalnim poliartritisom, izvanzglobnim simptomima (pluća, bubreg i dr.), te postupnim razaranjem zglobova. Posljedice su teške deformacije i invalidnost. U svijetu se prevalencija procjenjuje na 1 do 2% odraslih, a kod populacije starije od 65 godina i više od 10%. Reumatoidni artritis je 2,5 puta češći u žena nego u muškaraca. Reumatoidni faktor pozitivan je kod velike većine bolesnika
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