Epidemiology of pituitary tumors

Prema brojnim istraživanjima adenomi hipofize vrlo su česte neoplazme, a među njima su najčešći prolaktinomi. Suvremene epidemiološke studije pokazuju da su adenomi hipofize 3 do 5 puta učestaliji nego što se mislilo. Razvojem i dostupnošću modernih neuroradioloških metoda, kao i pouzdanim mjerenjem koncentracije hormona u plazmi bolesnika, dijagnoza adenoma hipofize postala je jednostavnija i pouzdanija. Sve češće susrećemo tzv. incidentalome, tzv. slučajno nađene tumore hipofize, kod potpuno asimptomatskih bolesnika, bez biokemijskih ili neuroloških promjena. Adenomi hipofize najčešće se dijagnosticiraju u mladih žena u reproduktivnoj dobi. Kod muškaraca i starijih osoba su rjeđi, a obično se dijagnosticiraju u uznapredovanoj fazi kao nefunkcionalni adenomi ili makroprolaktinomi s dominacijom neuroloških ispada u kliničkoj slici. U djetinjstvu su rijetki, a mogu se javiti i u obliku nasljednih adenoma hipofize. Atipični invazivni adenomi javljaju se u 15 % makroadenoma hipofize, a maligna alteracija izuzetno je rijetka. Cijena njihovog liječenja je visoka. Poznavanje epidemioloških podataka omogućuje kvalitetnije planiranje kliničke obrade u zdravstvenom sustavu uz smanjenje nepotrebnog morbiditeta, kao i troškova liječenja.According to numerous studies pituitary adenomas are very common neoplasms with prolactinomas as the most frequent. Contemporary epidemiological studies show that pituitary adenomas are 3 to 5 times more common than previously thought. The diagnosis of pituitary adenomas has become more simple and accurate with development and availability of modern neuroradiological methods as well as reliable measurement of hormone concentration in patient plasma. Today we frequently encounter pituitary adenomas which were found by coincidence in completely asymptomatic patients who have no laboratory or neurological abnormalities. These tumors are called incidentalomas. Pituitary adenomas are most frequently diagnosed among young women in their reproductive age. In men and older people they are less sommon and are usually recognized in advanced stages as nonfunctional adenomas or macroprolactinomas with neurological abnormalities as major clinical features. Childhood pituitary adenomas are also rare and can occur as inherited pituitary adenomas. Atypical invasive adenomas occur in 15 % of pituitary macroadenomas and malignant alteration is extremely rare. Although the price of treatment is very high, knowing epidemiological data enables better planning of resources in the health system and decreases the unnecessary morbidity and costs of treatment

Uloga medicinskog vještačenja u zaštiti prava građana tijekom povijesti

Based on secondary literature, a survey of particular forms of medical expertise over history is presented. The state-to-individual interaction in terms of personality and physical integrity protection, health care, etc., was observed. It was only after the 16th century that the development of anatomy was found to have become a decisive argument for convincing expertise in various trials. In Croatia, the course of medical expertise development was comparable to the close settings in the neighboring European countries. Major advances at the legislative, educational and professional levels took place in the second half of the 19th century. The subject of Forensic Medicine was introduced at Royal Academy of Jurisprudence as early as 1861; the book entitled Lěčnička izvěšća (visa reperta) za praktičnu porabu lěčnikov by Ivan Dežman (1841-1873) from 1868 offered the first systematic form of autopsy reports, whereas Kratka sudska medicina, a handbook in forensic medicine by Niko Selak (1861-1891) from 1889 denoted the beginnings of forensic medicine literature in Croatian language. It has been noted that medical expertise approach perceives man as a social being at the crossing of manifold impacts and influences, thus being always observed by physicians of various specialties. During centuries, medical expertise has been formed in conjunction with advances in medicine and science, and with the development of civil society. Medical expertise had gradually grown into a multidisciplinary field requiring high professionalism, ethical approach, continuous training and collaboration with various professions. This resulted in a compact and polyvalent discipline, in Croatia gradually formed as a special course in medical curriculum.Na temelju sekundarne literature u ovom radu se iznosi pregled pojedinih oblika medicinskog vještačenja tijekom povijesti. Prati se interakcija države i pojedinca u smislu zaštite osobnosti, tjelesnog integriteta, zaštite zdravlja i sl. Uočeno je da je razvoj anatomije postao ključan argument za uvjerljivu provedbu vještačenja u različitim parnicama istom nakon 16. stoljeća. Na području Hrvatske razvoj medicinskog vještačenja tekao je slično kao i u bliskim sredinama susjednih europskih zemalja. Tijekom druge polovine 19. stoljeća uočavaju se pomaci na zakonodavnoj, obrazovnoj i stručnoj ra¬zini. Sudska medicina kao predmet počinje se predavati na zagrebačkoj Kraljevskoj pravoslovnoj akademiji već od 1861. godine; djelo Ivana Dežmana (1841.-1873.) Lěčnička izvěšća (visa reperta) za praktičnu porabu lěčnikov iz 1868. ponudilo je prvi usustavljeni obrazac za pisanje obdukcijskih protokola, dok je priručnik sudske medicine Kratka sudska medicina Nike Selaka (1861.-1891.) iz 1889. obilježio početke sudskomedicinske literature pisane hrvatskim jezikom. Istaknuto je da je medicinsko vještačenje u okviru svog pristupa promatralo čovjeka kao društveno biće na razmeđi svekolikih utjecaja i njime su se oduvijek bavili liječnici različitih kompetencija. Medicinsko se vještačenje tijekom stoljeća oblikovalo u sprezi s napretkom medicine i znanosti, te izgradnjom civilnoga društva. Ono je postupno izrastalo u multidisciplinarno područje koje zahtijeva stručnost, etičnost u pristupu, kontinuirano usavršavanje i suradnju s različitim strukama. Samim time ovo se ustrojilo u kompaktnu i polivalentnu disciplinu te se i na području Hrvatske postupno oblikuje i kao zaseban predmet u okviru medicinskog kurikulum

Does mobile phone use cause brain tumors?

U današnje doba živimo u gustom moru polja elektromagnetskog zraèenja, za koje se procjenjuje da je 100 do 200 puta jaèe nego što je bilo prije sto godina. Dalekovodi, radari odašiljaèi, elektrièni vodovi, mobilni telefoni, televizori, digitalni satovi, CD/radioplejeri, raèunala i bežièni internet stvaraju elektromagnetska polja, a problem elektromagnetskog “zagaðenja” pogoršava upravo eksplozija bežiènih tehnologija. Tijekom rada, spomenuti ureðaji emitiraju elektromagnetsko zraèenje koje utjeèe na žive sustave. S obzirom na to da mobilne telefone za vrijeme razgovora prislanjamo na uho, dio njihovog zraèenja apsorbiraju tkiva glave, te postoji opravdana zabrinutost da njihovo korištenje utjeèe na razvoj tumora mozga i drugih fizioloških poremeæaja. U svijetu se progresivno poveæava broj korisnika i uèestalost korištenja mobilnih telefona, stoga je ovo pitanje od velikog javnozdravstvenog znaèaja. Mnogobrojne studije pokušale su ustanoviti utjeèe li korištenje mobilnih telefona na nastanak tumora mozga. Ovaj èlanak prikazuje problematiku vezanu uz štetne zdravstvene utjecaje uzrokovane korištenjem mobilnih telefona te komentira rezultate znaèajnijih studija iz tog podruèja.aWe live in a dense field of electromagnetic radiation today. It is estimated that this field is up to 200 times stronger than it was a 100 years ago. Power lines, radars, transmiters, electrical appliances, mobile phones, televisions, digital watches, CD/radio players, computers and wireless internet all produce electromagnetic fields, and the problem of electromagnetic “pollution” grows further with explosion of wireless technologies. These devices emit electromagnetic radiation that influences live organisms. When a mobile phone is used, it is held in a close proximity of head and a fraction of emited electromagnetic energy is absorbed by the user’s head. There is a concern that this electromagnetic radiation may cause brain tumors and other physiological disturbances. There is a growing number of new mobile phone users in the world making this concern a big publichealth issue. Many studies have tried to answer weather cell phone use causes brain tumors. This article examines the different aspects of mobile phone influence on genesis of brain tumors and comments the results of some of the important studies.elefo

Does mobile phone use cause brain tumors?

U današnje doba živimo u gustom moru polja elektromagnetskog zraèenja, za koje se procjenjuje da je 100 do 200 puta jaèe nego što je bilo prije sto godina. Dalekovodi, radari odašiljaèi, elektrièni vodovi, mobilni telefoni, televizori, digitalni satovi, CD/radioplejeri, raèunala i bežièni internet stvaraju elektromagnetska polja, a problem elektromagnetskog “zagaðenja” pogoršava upravo eksplozija bežiènih tehnologija. Tijekom rada, spomenuti ureðaji emitiraju elektromagnetsko zraèenje koje utjeèe na žive sustave. S obzirom na to da mobilne telefone za vrijeme razgovora prislanjamo na uho, dio njihovog zraèenja apsorbiraju tkiva glave, te postoji opravdana zabrinutost da njihovo korištenje utjeèe na razvoj tumora mozga i drugih fizioloških poremeæaja. U svijetu se progresivno poveæava broj korisnika i uèestalost korištenja mobilnih telefona, stoga je ovo pitanje od velikog javnozdravstvenog znaèaja. Mnogobrojne studije pokušale su ustanoviti utjeèe li korištenje mobilnih telefona na nastanak tumora mozga. Ovaj èlanak prikazuje problematiku vezanu uz štetne zdravstvene utjecaje uzrokovane korištenjem mobilnih telefona te komentira rezultate znaèajnijih studija iz tog podruèja.aWe live in a dense field of electromagnetic radiation today. It is estimated that this field is up to 200 times stronger than it was a 100 years ago. Power lines, radars, transmiters, electrical appliances, mobile phones, televisions, digital watches, CD/radio players, computers and wireless internet all produce electromagnetic fields, and the problem of electromagnetic “pollution” grows further with explosion of wireless technologies. These devices emit electromagnetic radiation that influences live organisms. When a mobile phone is used, it is held in a close proximity of head and a fraction of emited electromagnetic energy is absorbed by the user’s head. There is a concern that this electromagnetic radiation may cause brain tumors and other physiological disturbances. There is a growing number of new mobile phone users in the world making this concern a big publichealth issue. Many studies have tried to answer weather cell phone use causes brain tumors. This article examines the different aspects of mobile phone influence on genesis of brain tumors and comments the results of some of the important studies.elefo

Anestezija kod operacijskog zahvata na hipofizi

Pituitary tumors account for more than 10% of all intracranial tumors. They often present with symptoms of hormonal hypersecretion, although they may also cause hypopituitarism. Transsphenoidal pituitary surgery has become a commonly performed neurosurgical procedure, which has certain challenges for the anesthesiologist due to many distinct comorbidities associated with various adenomas. This article provides a review of perioperative concerns regarding transsphenoidal pituitary surgery, encountered in a number of these patients. Thorough understanding of preoperative assessment, intraoperative management and potential complications is fundamental for successful perioperative patient care and avoidance of morbidity and mortality.Tumori hipofize čine više od 10% svih intrakranijskih tumora. Oni se često manifestiraju simptomima hipersekrecije hormona, ali mogu isto tako izazvati hipopituitarizam. Transsfenoidna kirurgija hipofize postala je čest neurokirurški zahvat koji pred anesteziologa postavlja stanovite izazove zbog mnogih istodobno postojećih bolesti udruženih s raznim adenomima. Ovaj članak daje pregled pitanja koja treba razmotriti prije pristupanja transsfenoidnoj kirurgiji hipofize u većine ovih bolesnika. Potpuno razumijevanje prijeoperacijske procjene, intraoperacijskog zbrinjavanja i mogućih komplikacija bitno je za uspješnu perioperacijsku skrb, kao i za izbjegavanje pobola i smrtnosti

Accidental Finding of an Anomalous Spinal Nerve Root during Lumbar-Disc Surgery: A Case Report and a Review of Literature

Anomalies of lumbosacral nerve roots, even though are rare, have been well documented so far in the medical literature. The early diagnosis of these anomalies may be difficult and it is crucial to develop specific methods for depicting them. Preoperative diagnosis of anomalous lumbosacral spinal nerve roots using the magnetic resonance imaging is essential to facilitate thorough surgical planning in order to avoid unnecessary complications for the patient during surgery. The operative management of these anomalies depends on the patient’s neurological problems and while asymptomatic and accidentally diagnosed cases do not require treatment, patients who suffer low back or sciatic pain need surgical intervention in order to decompress nerve roots. We report a 45-years old woman presented with severe low back pain associated with left lumboischialgia. Intraoperative finding of an aberrant L5/S1 nerve root, optimal surgical therapy and different classifications are discussed together with a review of literature