QUALITY OF LIFE AND PERSONALITY TRAITS IN PATIENTS WITH COLORECTAL CANCER

Background: The aim of this study was to determine whether it is possible to predict quality of life in patients with colorectal cancer on the basis of personality dimensions from the Five-factor model. Subjects and methods: The study included 56 patients with colorectal cancer (40 men and 16 women), aged 48-87. The following instruments were used: the Questionnaire on General Information and Lifestyle Habits, the Quality of Life Scale, and the Neo Five-Factor Inventory. Results: The results of overall quality of life estimations of colorectal cancer patients were comparable to those of healthy people. Contrary to expectations, extraversion was not a significant quality of life predictor. Neuroticism as a personality trait was the only variable which consistently proved to be highly significant across analyses in the prediction of total quality of life, satisfaction with past life, future expectations, and comparison with others. Key determinants of neuroticism are a proneness to experiencing negative affects which makes adaptation difficult, a proneness to irrational ideas, reduced impulse control, ineffective coping strategies, the perception of poor control over oneself and others, and deeming one’s own resources to be insufficient to adequately cope with stress, thus resulting in a more negative quality of life estimation. Conclusion: These results support the conclusion that cognitive-behavioral interventions aimed at changing negative attributions, reducing tension and negative affects, acquiring more effective coping strategies, strengthening perceived personal control, redefining and re-conceptualizing quality of life, and seeking/receiving more adequate social support could lead to an improved quality of life in patients with colorectal cancer

History of the first hospice department in Croatia

U proljeće 1991. godine Službi za neurologiju i psihijatriju požeške bolnice pridružen je novi odjel čija je organizacija dijelom inspirirana "St Christopher’s Hospice" pokretom. Namijenjen je prije svega za palijativnu skrb bolesnika u krajnjem stadiju bolesti, te za pružanje pomoći obitelji u ophođenju sa oboljelim u završnom stadiju bolesti. Bio je otvoren za sve stanovnike bez obzira na dob, spol, vjeru i mogućnost plaćanja. Tijekom domovinskog rata teškoće su u financiranju hospicija i osipanje srednjeg medicinskog kadra dostigle kritičnu točku, što je rezultiralo raspuštanjem hospicijskog odjela nakon godinu dana ozbiljnog i humanog rada. Naše iskustvo može biti veoma korisno u analizi problema kako dio hospitala pretvoriti u hospicij u želji da se postigne stručna medicinska i psihološka pomoć bolesnicima i članovima njihove obitelji u krajnjem stadiju bolesti.In the spring of 1991 a new department, inspired by the "St Christopher’s Hospice" movement, was added to the Neuropsychiatric Service of the District General Hospital in Požega. The purpose of this new hospice was palliative care for the patients in terminal stages of illness. It was also intended to help the family communicate with the patient in the last stages of illiness. The department was open to all, regardless of sex, age, religion or ability to pay. During the war in Croatia the Hospital’s financial problems and a lack of nurses reached a critical point, which resulted in the closure of the hospice after a year of dedicated service. Our experience could be helpful in discussing how to transform a part of a hospital into a hospice, in order to provide better medical and psychological care for the patients in terminal stages of illiness and their families

Professional and scientific papers published by the doctora of Požega hospital from 1936-1996

Prva požeška bolnica otvorena je 1836. godine, a današnja moderna bolnica 1936. godine. Prvi stručni rad, nastao u požeškoj bolnici, objavio je u Liječničkom vjesniku 1939. godine njen ravnatelj, kirurg dr. Artur Horvat. Od tada je objavljeno 89 stručnih radova, obranjen jedan doktorat i 11 magisterija, te za kontinuirani stručni rad dodijeljeno pet primarijata. Danas Opća županijska bolnica Požega ima 56 specijalista različitih medicinskih grana i 16 specijalizanata, te vrlo visoki standard glede prostora i medicinske opreme.The hospital in Požega was first founded in 1836 and the present day modern hospital was opened in 1936. Its principal and surgeon Dr. Antun Horvat published the first professional paper made at Požega Hospital in Liječnički vjesnik in 1939. Since then, 89 professional papers were published and one Ph.D. dissertation as well as 11 MA these was defended. Five doctors were awarded the title of primarius for continous professional work. Today Požega Hospital employs 56 specialists in different fields of medicine and 16 residents. It sets very high standards for hospital rooms and medical equipment

Minimalno invazivne metode u lije^enju raka dojke: pregled protokola

One can find an increasing number of articles with minimally invasive methods in current literature concerning local treatment of breast cancer. The methods can be divided in two groups: percutaneous excision methods and thermal ablation methods. Thermal ablation methods are based on the premise that malignant tissue is more sensitive to hyperthermia than normal cells. We are comparing advantages and disadvantages of current minimally invasive methods for treatment of early stage breast cancers, showing differences and advantages over breast-conserving surgery. Available published studies and protocols are overviewed. Most of the published works emphasize advantages over classic breast surgery such as: lower costs, less trauma for patients and smaller invasiveness. All methods involving thermal procedures require surgical excision afterwards for evaluation of necrosis and patohistological evaluation of the lesion. The effect of these treatment methods should be safety, painlessness, good cosmetic results and lower treatment costs. If results of such methods are to be comparable to BCS, we can expect their integration in clinical practice.U suvremenom pristupu lokalnog liječenja tumora dojke sve više prostora u stručnim publikacijama zauzimaju izvješća o primjeni tzv. minimalno invazivnih metoda, među kojima su dvije osnovne skupine: perkutane ekscizijske metode i termalne ablacijske metode. Temelj termalnih ablacijskih postupaka u liječenju tumora dojke leži u činjenici da tumori pokazuju veću senzitivnost na hipertermička oštećenja od normalnih stanica. U radu se nastoje komparacijom prednosti i nedostataka ovih suvremenih minimalno invazivnih metoda u liječenju tumora dojke nižih stadija, utvrditi razlika i eventualna prednost tih postupaka prema poštednim kirurškim zahvatima . Pregledani su dostupni publicirani protokoli i iskustva u provođenju perkutanih bioptičkih metoda i nekih termalnih ablacijskih metoda u minimalno invazivnoj kirurgiji dojke. U većini pregledanih publikacija i protokola, naglašena je prednost opisanih metoda nad klasičnom kirurgijom dojke, koja je izražena u nižim troškovima, smanjenju psihičkih trauma liječenih bolesnica i niskom razinom invazivnosti. U gotovo svim pregledanim protokolima koji se odnose na tzv. termalne metode uočena je potreba za naknadnom kirurškom ekscizijom radi procjene stupnja nekroze i patohistološke provjere lezije. Uspješnost liječenja tumora dojke ovim metodama bi se trebala temeljiti na sigurnosti, bezbolnosti, dobrim kozmetičkim rezultatima i nižim troškovima liječenja. Ove bi metode mogle doživjeti punu primjenu u kliničkoj praksi ako se njima postigne rezultat ekvivalentan onome koji se postiže sa poštednim kirurškim zahvatima (BCS)

Pregnancy and Vaginal Delivery in Epidural Analgesia in Woman with Cerebrospinal Fluid Shunt

Hydrocephalus is a medical condition characterized by enlargement of cerebral ventricles due to abnormal cerebro- spinal fluid accumulation. Hydrocephalic women with cerebrospinal fluid (CSF) shunts are now surviving to reproduc- tive age, but still there are doubts regarding the mode of delivery, analgesia and anesthesia. Postpartal complications are more frequently described in deliveries ended by cesarean section than in spontaneous vaginal deliveries. We present a case of labor in the 32-year old woman, with congenital hydrocephalus and a preexisting ventriculoperitoneal (VP) shunt. After thorough review of current literature, we came to conclusion that without absolute neurosurgical indication or acute development of listed symptoms (headaches, irritability, light sensitivity, hyperesthesia nausea, vomiting, ver- tigo, migraines, seizures, weakness in the arms or legs, strabismus and double vision) the best way to finish the preg- nancy of woman with VP shunt is spontaneous vaginal delivery with the use of epidural analgesia, mediolateral episiotomy and vacuum extraction

POUZDANOST GINEKOLOŠKOG PREGLEDA U DIFERENCIJALNOJ DIJAGNOSTICI UPALE CRVULJKA ŽENA REPRODUKTIVNE DOBI

The aim of the study was to examine the differential-diagnostical reliability of gynaecological examination in women of reproductive age who have shown clinical symptoms of acute abdomen in the lower right quadrant, with a dilemma whether this was due to acute appendicitis or acute gynaecological disease. Patients and methods. During the 15-year period (from 1988 to 2003), there were 530 women of reproductive age who underwent surgery for suspected acute appendicitis at County Hospital in Požega. Case histories, intraoperative findings, pathohistological findings, as well as consultative gynaecological findings were analysed retrospectively. For statistical analysis .2 test was used, with measuring confidence intervals at the level of 95% (p<0.05). Results. Out of 530 women of reproductive age included in the study, 159 of them were referred to a gynaecological examination (group A) and 371 of them were not (group B). In the group A (n=159), 34 (21.4%) women were diagnosed with a gynaecological disease intraoperatively even though the previous palpatory gynaecological findings were normal. In the group B (n=371), 22 (5.9%) patients were diagnosed with a gynaecological disease intraoperatively but these patients were not referred to a gynaecologist at all. Among all the women at 34 was diagnosed an ovarian cyst, at 12 a tubo-ovarian abscess, at 9 a pelvic inflammatory disease and at 1 an ovarian torsion. A significant (p<0.05, .2=26.516; odds ratio=4.31; CI 95%=2.43–7.65) unreliability of bimanual gynae-cological examination was found in diagnosing an acute gynaecological pathology in female patients who were referred to a consultation by a surgeon. Conclusion. The results of this study suggest a significant unreliability of bimanual gynaeco-logical examination in differential diagnosis of acute abdomen in women of reproductive age. Clinical work should, at any rate, include other diagnostical methods (US; CT; laparoscopy, MRI), aiming at a more precise diagnosis, which would then lead to the application of a more adequate therapy.Cilj rada bio je istražiti diferencijalno dijagnostičku pouzdanost ginekološkog pregleda kod žena reproduk- tivne dobi koje imaju kliničku sliku akutnog abdomena desnog donjeg kvadranta uz postojanje dileme radi li se o akutnoj upali crvuljka ili akutnoj ginekološkoj bolesti. Bolesnici i metode. U 15 godišnjem razdoblju (od 1988. do 2003. godine) u Općoj županijskoj bolnici Požega operirano je 530 žena reproduktivne dobi zbog sumnje na akutni apendicitis. Retro-spektivno su analizirane povijesti bolesti, intraoperacijski nalaz, patohistološki nalaz, te konzilijarni ginekološki nalaz. Statistička analiza učinjena je .2 testom uz mjerenje intervala pouzdanosti na razini od 95% (p<0,05). Rezultati. Od 530 žena reproduktivne dobi uključenih u studiju, 159 je bilo upućeno na ginekološki pregled (skupina A), a 371 nije (skupina B). U skupini A (N=159) intraoperacijski je kod 34 žene nađena ginekološka bolest iako je prethodni palpatorni ginekološki nalaz bio uredan. U skupini B (N=371) intraoperacijski je kod 22 bolesnice nađena ginekološka bolest, ali te bolesnice nisu bile upućene ginekologu. Od svih 530 žena u 34 nađena je rupturirana ovarijalna cista, tubo-ovarijalni absces u 12 bolesnica, u 9 upalni proces u maloj zdjelici i torzija ovarija u 1 bolesnice. Nađena je značajna (p<0,05, .2=26,516; odds ratio=4,31, CI 95%=2,43–7,65) nepouzdanost bimanualnog ginekološkog pregleda radi utvrđivanja akutne ginekološke patologije kod pacijentica upućenih na konzultaciju kirurga. Zaključak. Rezultati ovog rada upućuju na značajnu nepouz-danost bimanuelnog ginekološkog pregleda u diferencijalnoj dijagnostici akutnog abdomena kod žena reproduktivne dobi. Svakako treba u kliničkom radu uključiti druge dijagnostičke metode (UZV, CT, laparoskopija, MRI) zbog postavljanja sigurnije dijagnoze, pa time i primjenjivanja adekvatnije terapije

Minimalno invazivne metode u lije^enju raka dojke: pregled protokola

One can find an increasing number of articles with minimally invasive methods in current literature concerning local treatment of breast cancer. The methods can be divided in two groups: percutaneous excision methods and thermal ablation methods. Thermal ablation methods are based on the premise that malignant tissue is more sensitive to hyperthermia than normal cells. We are comparing advantages and disadvantages of current minimally invasive methods for treatment of early stage breast cancers, showing differences and advantages over breast-conserving surgery. Available published studies and protocols are overviewed. Most of the published works emphasize advantages over classic breast surgery such as: lower costs, less trauma for patients and smaller invasiveness. All methods involving thermal procedures require surgical excision afterwards for evaluation of necrosis and patohistological evaluation of the lesion. The effect of these treatment methods should be safety, painlessness, good cosmetic results and lower treatment costs. If results of such methods are to be comparable to BCS, we can expect their integration in clinical practice.U suvremenom pristupu lokalnog liječenja tumora dojke sve više prostora u stručnim publikacijama zauzimaju izvješća o primjeni tzv. minimalno invazivnih metoda, među kojima su dvije osnovne skupine: perkutane ekscizijske metode i termalne ablacijske metode. Temelj termalnih ablacijskih postupaka u liječenju tumora dojke leži u činjenici da tumori pokazuju veću senzitivnost na hipertermička oštećenja od normalnih stanica. U radu se nastoje komparacijom prednosti i nedostataka ovih suvremenih minimalno invazivnih metoda u liječenju tumora dojke nižih stadija, utvrditi razlika i eventualna prednost tih postupaka prema poštednim kirurškim zahvatima . Pregledani su dostupni publicirani protokoli i iskustva u provođenju perkutanih bioptičkih metoda i nekih termalnih ablacijskih metoda u minimalno invazivnoj kirurgiji dojke. U većini pregledanih publikacija i protokola, naglašena je prednost opisanih metoda nad klasičnom kirurgijom dojke, koja je izražena u nižim troškovima, smanjenju psihičkih trauma liječenih bolesnica i niskom razinom invazivnosti. U gotovo svim pregledanim protokolima koji se odnose na tzv. termalne metode uočena je potreba za naknadnom kirurškom ekscizijom radi procjene stupnja nekroze i patohistološke provjere lezije. Uspješnost liječenja tumora dojke ovim metodama bi se trebala temeljiti na sigurnosti, bezbolnosti, dobrim kozmetičkim rezultatima i nižim troškovima liječenja. Ove bi metode mogle doživjeti punu primjenu u kliničkoj praksi ako se njima postigne rezultat ekvivalentan onome koji se postiže sa poštednim kirurškim zahvatima (BCS)

Uporaba piezoelektričnog svojstva u poboljšanju kvalitete instrumenata i sigurnosti bolesnika u laparoskopskoj kirurgiji

The piezoelectric properties of some natural crystals and polymers can also be used in surgery. For this purpose, a prototype of an endoscopic instrument was constructed with piezoelectric material attached to its working end with the aim of recognizing pulsating blood vessels during laparoscopic surgery. To test the properties of the new instrument in laboratory conditions, simulated blood circulation was used with the possibility of changing pressure and frequency. The instrument was tested in the pressure range of 40-180 mm Hg at constant frequency of 72/min and frequency range of 36-130 beats per minute at constant pressure of 120 mm Hg. Test results showed that the instrument with certainty recognized a pulsating “blood vessel” in the expected pressure ranges and at different blood pump frequencies. Given the piezoelectric material’s very small dimensions and flexible form, it can be installed at the working end of most standard laparoscopic instruments and thus significantly increase certainty in the recognition of arteries during surgery, which would reduce the possibility of their injury or accidental ligation.Piezoelektrična svojstva nekih prirodnih kristala i nekih polimera moguće je koristiti i u kirurgiji. U tu svrhu konstruiran je prototip endoskopskog instrumenta na čijem je radnom dijelu ugrađen piezoelektrični materijal s ciljem prepoznavanja pulzirajućih krvnih žila tijekom laparoskopskih operacija. Za ispitivanje svojstava novoga instrumenta u laboratorijskim uvjetima korišten je simulirani krvotok s mogućnošću mijenjanja tlaka i frekvencije. Rad instrumenta je ispitivan u rasponu tlakova 40-180 mm Hg uz konstantnu frekvenciju 72/min, te u rasponu frekvencija 36-130 otkucaja u minuti uz konstantan tlak 120 mm Hg. Rezultati ispitivanja pokazuju da instrument sa sigurnošću prepoznaje pulzirajuću „krvnu žilu“ u očekivanom rasponu tlakova i pri različitim frekvencijama rada krvne pumpe. S obzirom na to da se radi o vrlo malim dimenzijama i prilagodljivim oblicima piezoelektričkog materijala, moguće ga je postaviti na radni dio većine standardnih laparoskopskih instrumenata i time značajno povećati sigurnost prepoznavanja arterija tijekom operacijskog zahvata, što bi smanjilo mogućnost njihove ozljede ili slučajnog podvezivanja

Synchronous caecal small-cell neuroendocrine carcinoma and adenocarcinoma of the rectum

Neuroendokrini karcinom malih stanica debeloga crijeva rijedak je entitet s najčešće lošom prognozom. Osamdesetogodišnja žena podvrgnuta je operaciji debeloga crijeva zbog sinkronog tumora rektuma i cekuma. Patohistološka analiza tumora cekuma pokazala je trabekularne i čvrste nakupine, relativno uniformne male do srednje velike epitelne stanice, oskudne citoplazme, a u vezivnom tkivu bilo je dosta mitoza s većim područjima nekroze. Imunohistokemija je bila pozitivna na kromogranin A. Tumor je dijagnosticiran kao neuroendokrini karcinom malih stanica cekuma. Osim toga, tumor rektuma pokazao je mikroskopske nalaze u skladu s IIA stadijem adenokarcinoma. Imunohistokemijski panel pokazao je da je tumor bio negativan na neuroendokrine markere. Nije bilo kliničkoga nalaza koji ukazuje na pojačanu sekreciju hormona. Metastaze karcinoma nisu nađene. Provedena je postoperativna kemoterapija. Pacijentica je i dalje živa, dobrog općega stanja, bez znakova progresije tumora.Small-cell neuroendocrine colon carcinoma is a rare entity with a usually poor prognosis. An 80-year-old female had colon cancer surgery due to synchronous tumour of the rectum and caecum. Pathohystological analysis of the caecal tumour showed trabecular and solid clusters, relatively uniformed small to middle sized epithelial cells, deficient cytoplasm and there were a great number of mitosis with larger areas of necrosis in the connective tissue. The immunohistochemistry was positive for chromogranin A. The caecal tumour was diagnosed as a small-cell neuroendocrine carcinoma. In addition, the rectal tumour showed microscopic findings consistent with stage IIA adenocarcinoma. The immunohistochemical panel showed that the tumour was negative for neuroendocrine markers. There were no clinical findings suggestive of hormone hypersecretion. Cancer metastases were not found. Postoperative chemotherapy was applied. The patient is still alive, in good general condition and with no signs of tumour progression

Effect of Pesticides on Wound Contraction

Agricultural injuries are a complex surgical problem, especially because of frequently extensive skin lesions prone to infection and delayed healing. The aim of the study was to assess the local effect of pesticides, chemical substances widely used in agriculture, on wound healing, especially on wound contraction. Local effects of the combined herbicide composed of atrazine and dual (Primextra) and insecticide alphametrin (Fastac 10% SC) on primary wound healing were assessed in a bioassay performed in 18 New Zealand white rabbits. Relative size of the wound, measured on days 0, 1, 3, 6, 9 and 12 of wounding was analyzed by two-factor analysis of variance with repeat measurements. The activity of the process of restoration was assessed on histopathologic preparations obtained after the last measurement. Results of the study showed the final wound contraction to be smaller and the process of healing slower in the experimental groups of animals. Histopathology revealed defects of epithelialization, phasic delay in healing, infiltration with eosinophilic granulocytes, and decreased density of newly formed collagen. Pesticides were concluded to have adverse local effects on the wound, causing impairment of the mechanisms of healing