Prijeoperacijska procjena bolesnika s osteogenesis imperfecta

Osteogenesis imperfecta (OI) is an inherited disorder of the connective tissue the primary manifestation of which is an increased susceptibility to fractures. Patients often require orthopaedic treatment of fractures and resultant deformities. Commonly encountered intraoperative complications include diffi cult airway with easily fractured teeth, patient positioning problems, intraoperative bleeding, hypothermia, respiratory compromise due to skeletal deformity, cardiac problems or basilar invagination caused by congenital anomalies, and very rarely development of perioperative hyperthermia. Therefore, multidisciplinary approach to preoperative assessment of patients with OI, including identifi cation of risk factors and optimization of health before surgery is needed.Osteogenesis imperfecta (OI) je nasljedna bolest vezivnog tkiva, a njezina glavna manifestacija je povećana sklonost prijelomima. Ovi bolesnici često zahtijevaju ortopedsko liječenje prijeloma i posljedičnih deformiteta. Česte intraoperacijske komplikacije su otežani dišni put s lako lomljivim zubima, problemi pozicioniranja bolesnika, intraoperacijsko krvarenje, hipotermija, respiracijski poremećaji zbog koštanih deformacija, srčani problemi ili bazilarna invaginacija uzrokovana prirođenim anomalijama te vrlo rijetko razvoj perioperacijske hipertermije. Stoga je neophodan multidisciplinski pristup prijeoperacijskoj procjeni bolesnika s OI, uključujući utvrđivanje rizičnih čimbenika i postizanje optimalnog zdravstvenog stanja prije operacije

Intraoperativni nalazi adneksalnih tumora prilikom carskom reza u razdoblju od 11 godina

Finding of adnexal masses during pregnancy is an exceptional event. The incidence is less than 5% and most cases resolve spontaneously as the pregnancy progresses. Our goal was to describe a series of patients with adnexal masses in pregnancy, found incidentally during Cesarean section (CS), as well as the histopathological characteristics of the masses extirpated. We retrospectively reviewed medical records of patients with previously unrecognized adnexal masses removed at CS in the period of 11 years, from 2000 to 2010 in our Hospital. The number of total live births was 32 603 and 7 060 of them were by CS (21.65%). There were 49 cases of incidental adnexal masses (49/7060, 0.69%), out of which 13 (26.5%) were 5 cm or greater in size. All of the masses were removed at CS. The pathologic diagnosis of the ovarian masses was as follows: simple serous cyst 27 (55.1%), cystadenoma mucinosum 6 (12.2%), teratoma adultum 5 (10.2%), fibroma 2 (4.08%), corpus luteum 2 (4.08%), endometrioma 2 (4.08%), cystadenofybroma serosum 1 (2.04%), cystadenoma serosum 1 (2.04%), luteoma 1 (2.04%), teratoma immaturum 1 (2.04%), dermoid cyst 1 (2.04%). Extirpation procedure during CS did not alter the morbidity of the operation, it enabled exclusion of malignancy and avoided possible surgical procedures in the future for the patient, although there are controversial data in the literature about performing it during CS. Our conclusion is that incidental masses detected at the time of CS should be extirpated in order to exclude malignancy and to avoid any additional surgical procedure following caesarean section because the extirpation itself does not change the outcome of the operation.Slučajan nalaz adneksalnih tumora tijekom trudnoće je rijetkost. Učestalost je manja od 5%, a većina ih spontano regredira kako trudnoća napreduje. Cilj našeg istraživanja bio je prikazati i analizirati pacijentice s adneksalnim tumorima u trudnoći, otkrivenim slučajno tijekom carskog reza, kao i histopatološke karakteristike uklonjenih tumora te rezultate usporediti s rezultatima sličnih istraživanja u literaturi. Pregledali smo medicinsku dokumentaciju pacijentica čija je trudnoća dovršena carskim rezom, a koje su imale prije trudnoće neprepoznate adneksalne tumore, koji su potom uklonjeni tijekom carkog reza. Ovo retrospektivno istraživanje obuhvatilo je razdoblje od 11 godina, od 2000.-2010. u Kliničkoj bolnici „Sv. Duh“ u Zagrebu. Broj poroda u navedenom razdoblju bio je 32 603, a 7 060 ih je dovršeno carskim rezom (21.65%). Pronađeno je 49 slučajeva adneksalnih tumora (49/7060, 0.69%), od kojih su 13 (26.5%) bili jednaki ili veći od 5 cm. Svi tumori pronađeni tijekom carskog reza bili su i uklonjeni. Patohistološke dijagnoze tumorskih masa prema redu učestalosti bile su: jednostavna serozna cista 27 (55.1%), mucinozni cistadenom 6 (12.2%), adultni teratom 5 (10.2%), fibrom 2 (4.08%), corpus luteum 2 (4.08%), endometriom 2 (4.08%), serozni cistadenofibrom 1 (2.04%), serozni cistadenom 1 (2.04%), luteom 1 (2.04%), nezreli teratom 1 (2.04%) i dermoid 1 (2.04%). Postupak ekstirpacije adneksalnog tumora tijekom carskog reza nije utjecao na ishod zahvata, a omogućio je isključivanje maligniteta tumorske tvorbe te je time izbjegnut mogući budući kirurški zahvat za pacijenticu iako su podaci o izvođenju takvog zahvata tijekom carskog reza u literaturi kontroverzni. Naš zaključak je da adneksalni tumori uočeni tijekom carskog reza trebaju biti i uklonjeni kako bi se isključio malignitet i izbjegao budući kirurški zahvat

Intraoperativni nalazi adneksalnih tumora prilikom carskom reza u razdoblju od 11 godina

Finding of adnexal masses during pregnancy is an exceptional event. The incidence is less than 5% and most cases resolve spontaneously as the pregnancy progresses. Our goal was to describe a series of patients with adnexal masses in pregnancy, found incidentally during Cesarean section (CS), as well as the histopathological characteristics of the masses extirpated. We retrospectively reviewed medical records of patients with previously unrecognized adnexal masses removed at CS in the period of 11 years, from 2000 to 2010 in our Hospital. The number of total live births was 32 603 and 7 060 of them were by CS (21.65%). There were 49 cases of incidental adnexal masses (49/7060, 0.69%), out of which 13 (26.5%) were 5 cm or greater in size. All of the masses were removed at CS. The pathologic diagnosis of the ovarian masses was as follows: simple serous cyst 27 (55.1%), cystadenoma mucinosum 6 (12.2%), teratoma adultum 5 (10.2%), fibroma 2 (4.08%), corpus luteum 2 (4.08%), endometrioma 2 (4.08%), cystadenofybroma serosum 1 (2.04%), cystadenoma serosum 1 (2.04%), luteoma 1 (2.04%), teratoma immaturum 1 (2.04%), dermoid cyst 1 (2.04%). Extirpation procedure during CS did not alter the morbidity of the operation, it enabled exclusion of malignancy and avoided possible surgical procedures in the future for the patient, although there are controversial data in the literature about performing it during CS. Our conclusion is that incidental masses detected at the time of CS should be extirpated in order to exclude malignancy and to avoid any additional surgical procedure following caesarean section because the extirpation itself does not change the outcome of the operation.Slučajan nalaz adneksalnih tumora tijekom trudnoće je rijetkost. Učestalost je manja od 5%, a većina ih spontano regredira kako trudnoća napreduje. Cilj našeg istraživanja bio je prikazati i analizirati pacijentice s adneksalnim tumorima u trudnoći, otkrivenim slučajno tijekom carskog reza, kao i histopatološke karakteristike uklonjenih tumora te rezultate usporediti s rezultatima sličnih istraživanja u literaturi. Pregledali smo medicinsku dokumentaciju pacijentica čija je trudnoća dovršena carskim rezom, a koje su imale prije trudnoće neprepoznate adneksalne tumore, koji su potom uklonjeni tijekom carkog reza. Ovo retrospektivno istraživanje obuhvatilo je razdoblje od 11 godina, od 2000.-2010. u Kliničkoj bolnici „Sv. Duh“ u Zagrebu. Broj poroda u navedenom razdoblju bio je 32 603, a 7 060 ih je dovršeno carskim rezom (21.65%). Pronađeno je 49 slučajeva adneksalnih tumora (49/7060, 0.69%), od kojih su 13 (26.5%) bili jednaki ili veći od 5 cm. Svi tumori pronađeni tijekom carskog reza bili su i uklonjeni. Patohistološke dijagnoze tumorskih masa prema redu učestalosti bile su: jednostavna serozna cista 27 (55.1%), mucinozni cistadenom 6 (12.2%), adultni teratom 5 (10.2%), fibrom 2 (4.08%), corpus luteum 2 (4.08%), endometriom 2 (4.08%), serozni cistadenofibrom 1 (2.04%), serozni cistadenom 1 (2.04%), luteom 1 (2.04%), nezreli teratom 1 (2.04%) i dermoid 1 (2.04%). Postupak ekstirpacije adneksalnog tumora tijekom carskog reza nije utjecao na ishod zahvata, a omogućio je isključivanje maligniteta tumorske tvorbe te je time izbjegnut mogući budući kirurški zahvat za pacijenticu iako su podaci o izvođenju takvog zahvata tijekom carskog reza u literaturi kontroverzni. Naš zaključak je da adneksalni tumori uočeni tijekom carskog reza trebaju biti i uklonjeni kako bi se isključio malignitet i izbjegao budući kirurški zahvat

Evaluation of nurses' workload in intensive care unit of a tertiary care university hospital in relation to the patients' severity of illness: a prospective study

BACKGROUNDS: Costs of intensive care reach up to 30% of the hospital budget with workforce expenses being substantial. Determining proper nurse-patient ratio is necessary for optimizing patients' health related outcomes and hospitals' cost effective functioning. ----- OBJECTIVES: To evaluate nurses' workload using Nine Equivalents of Nursing Manpower Use Score and Nursing Activities Score scoring systems while assessing correlation between both scores and the severity of illness measured by Simplified Acute Physiology Score II. ----- DESIGN: A Prospective study SETTINGS: Cardiac Surgery Intensive Care Unit of the Clinical Hospital Centre Rijeka, Croatia, from October 2014 to February 2015. This Intensive Care Unit has 3 beds that can be expanded upon need. ----- PARTICIPANTS: The study included 99 patients treated at this Unit during the study's period. The scores were obtained by 6 nurses, working in 12h shifts. ----- METHODS: Measurements were obtained for each patient 24h after admission and subsequently twice a day, at the end of the day shift (7pm) and at the end of the night shift (7 am). The necessary data were obtained from the patient's medical records. ----- RESULTS: Nursing Activities Score showed significantly higher number of nurses are required for one 12h shift (Z=3.76, p<0.001). Higher scores were obtained on day shifts vs. night shifts. (Nursing Manpower Use Score, z=3.25, p<0.001; Nursing Activities Score, z=4.16, p<0.001). When comparing Nursing Activities Score and Nursing Manpower Use Score during the week, we calculated higher required number of nurses on weekdays than on weekends and holidays, (Nursing Manpower Use Score, p<0.001; Nursing Activities Score, p<0.001). Correlation analysis of Nursing Activities Score and Nursing Manpower Use Score with Simplified Acute Physiology Score II has shown that Nursing Manpower Use Score positively associated with severity of disease, while Nursing Activities Score shows no association. ----- CONCLUSION: Both scores can be used to estimate required number of nurses in 12-h shifts, although Nursing Activities Score seems more suitable for units with prolonged length of stay, while Nursing Manpower Use Score appears better for units with shorter duration of stay (up to four days). Higher workload measured by Nursing Manpower Use Score scale can be predicted with higher Simplified Acute Physiology Score II. However, with low Simplified Acute Physiology Score II scores it cannot be assumed that the nursing workload will also be low. Further research is needed to determine the best tool to asses nursing workload in intensive care units

Stable Gastric Pentadecapeptide BPC 157 Therapy of Rat Glaucoma

Cauterization of three episcleral veins (open-angle glaucoma model) induces venous congestion and increases intraocular pressure in rats. If not upgraded, one episcleral vein is regularly unable to acquire and take over the whole function, and glaucoma-like features persist. Recently, the rapid upgrading of the collateral pathways by a stable gastric pentadecapeptide BPC 157 has cured many severe syndromes induced by permanent occlusion of major vessels, veins and/or arteries, peripherally and centrally. In a six-week study, medication was given prophylactically (immediately before glaucoma surgery, i.e., three episcleral veins cauterization) or as curative treatment (starting at 24 h after glaucoma surgery). The daily regimen of BPC 157 (0.4 µg/eye, 0.4 ng/eye; 10 µg/kg, 10 ng/kg) was administered locally as drops in each eye, intraperitoneally (last application at 24 h before sacrifice) or per-orally in drinking water (0.16 µg/mL, 0.16 ng/mL, 12 mL/rat until the sacrifice, first application being intragastric). Consequently, all BPC 157 regimens immediately normalized intraocular pressure. BPC 157-treated rats exhibited normal pupil diameter, microscopically well-preserved ganglion cells and optic nerve presentation, normal fundus presentation, normal retinal and choroidal blood vessel presentation and normal optic nerve presentation. As leading symptoms, increased intraocular pressure and mydriasis, as well as degeneration of retinal ganglion cells, optic nerve head excavation and reduction in optic nerve thickness, generalized severe irregularity of retinal vessels, faint presentation of choroidal vessels and severe optic nerve disc atrophy were all counteracted. In conclusion, we claim that the reversal of the episcleral veins cauterization glaucoma appeared as a consequence of the BPC 157 therapy of the vessel occlusion-induced perilous syndrome