11 research outputs found
Ovarian reserve before and after endometrioma surgery
Ovarijska rezerva je konaÄan broj jajnih stanica prisutnih u ovariju koje su dostupne za folikulogenezu. Procjena ovarijske rezerve bitna je u evaluaciji i lijeÄenju neplodnosti, te u predviÄanju ishoda metoda medicinske oplodnje. Kako nijedan test danas dostupan ne mjeri direktno ukupan broj oocita, procjena se vrÅ”i posredno mjerenjem ovarijskih hormona i poznavanjem fizioloÅ”ke osnove reprodukcije. Testove za mjerenje ovarijske rezerve možemo podijeliti na pasivne i dinamiÄke. Pasivni ukljuÄuju mjerenje serumskih koncentracija FSH, estradiola, AMH, inhibina-B, mjerenje broja antralnih folikula, te odreÄivanje volumena i vaskularizacije ovarija. U dinamiÄke testove ubrajamo provokacijski test klomifen citratom, egzogeni FSH test te provokacijski test gonadotropinima. Kako niti jedna od ovih metoda nije idealna, najbolji uvid u ovarijsku rezervu dobivamo kombinacijom nekoliko njih. Endometriom je benigna, o estrogenu ovisna ovarijska cista, koja je usko povezana s neplodnoÅ”Äu i sa smanjenom ovarijskom rezervom. Pretpostavljenih mehanizama te povezanosti ima nekoliko meÄu kojima su najznaÄajniji oÅ”teÄenje jajnika samom prisutnoÅ”Äu endometrioma i smanjenje ovarijske rezerve tijekom operacije uslijed uklanjanja zdravog tkiva ovarija koje se nalazi u okolini ciste. Mnogo je dijagnostiÄkih metoda pomoÄu kojih možemo utvrditi prisutnost endometrioma s velikom vjerojatno, ali jedina sigurna dijagnoza je patohistoloÅ”ki nalaz. Nema konsenzusa po pitanju naÄina lijeÄenja endometrioma, iako se danas u pravilu najÄeÅ”Äe pristupa laparoskopskoj operaciji. Mnoge studije su pokazale kako je ovarijska rezerva neupitno smanjena nakon operacije endometrioma iako prema dosadaÅ”njim saznanjima to ne utjeÄe drastiÄno na stopu zanoÅ”enja poÅ”to funkcija kontralateralnog jajnika ostaje normalna.Ovarian reserve is defined as the number of oocytes in the ovary that are available for folliculogenesis. Determining ovarian reserve is important in evaluating and treating infertility, as well as in predicting the outcomes of assisting reproduction methods. There is no test available today that could directly measure number of oocytes. Therefore, in order to estimate the ovarian reserve different tests are being used, including measuring levels of hormones and knowing the physiological grounds for reproduction. Test used in determining the ovarian reserve can be divided in two groups, passive and dynamic. Passive tests include measuring serume levels of FSH, oestradiol, AMH, inhibin-B as well as measuring AFC, ovarian volume and ovarian vascularisation. Dynamic tests are clomiphene citrate challenge test, egsogeneous FSH test and gonadotrophins challenge test. As neither one of this methods is considered to be ideal, the best way to determine ovarian reserve is to combine them. Endometrioma is a benigb, oestrogen dependant cyst, which is strongly related to infertility and to diminished ovarian reserve. There are several suggested mechanisms to explain that correlation, the most significant being damage of the ovary caused by the presence of the endometrioma itself and removal of healthy ovarian tissue during surgery. Many diagnostic methods are being used to determine the presence of endomerioma, but the only confirmation is the pathohistological one. No consensus has been reached regarding endometrioma treatment. However, laparoscopic surgery is the most common way to treat endometiroma. Many studies have shown that the ovarian reserve is undoubtedly diminished following endometrioma surgery. However, studies have also shown that pregnancy rates in such patients do not seem to be significantly lower which is mostly atributed to the normal fucntion of the contralateral ovary
Ovarian reserve before and after endometrioma surgery
Ovarijska rezerva je konaÄan broj jajnih stanica prisutnih u ovariju koje su dostupne za folikulogenezu. Procjena ovarijske rezerve bitna je u evaluaciji i lijeÄenju neplodnosti, te u predviÄanju ishoda metoda medicinske oplodnje. Kako nijedan test danas dostupan ne mjeri direktno ukupan broj oocita, procjena se vrÅ”i posredno mjerenjem ovarijskih hormona i poznavanjem fizioloÅ”ke osnove reprodukcije. Testove za mjerenje ovarijske rezerve možemo podijeliti na pasivne i dinamiÄke. Pasivni ukljuÄuju mjerenje serumskih koncentracija FSH, estradiola, AMH, inhibina-B, mjerenje broja antralnih folikula, te odreÄivanje volumena i vaskularizacije ovarija. U dinamiÄke testove ubrajamo provokacijski test klomifen citratom, egzogeni FSH test te provokacijski test gonadotropinima. Kako niti jedna od ovih metoda nije idealna, najbolji uvid u ovarijsku rezervu dobivamo kombinacijom nekoliko njih. Endometriom je benigna, o estrogenu ovisna ovarijska cista, koja je usko povezana s neplodnoÅ”Äu i sa smanjenom ovarijskom rezervom. Pretpostavljenih mehanizama te povezanosti ima nekoliko meÄu kojima su najznaÄajniji oÅ”teÄenje jajnika samom prisutnoÅ”Äu endometrioma i smanjenje ovarijske rezerve tijekom operacije uslijed uklanjanja zdravog tkiva ovarija koje se nalazi u okolini ciste. Mnogo je dijagnostiÄkih metoda pomoÄu kojih možemo utvrditi prisutnost endometrioma s velikom vjerojatno, ali jedina sigurna dijagnoza je patohistoloÅ”ki nalaz. Nema konsenzusa po pitanju naÄina lijeÄenja endometrioma, iako se danas u pravilu najÄeÅ”Äe pristupa laparoskopskoj operaciji. Mnoge studije su pokazale kako je ovarijska rezerva neupitno smanjena nakon operacije endometrioma iako prema dosadaÅ”njim saznanjima to ne utjeÄe drastiÄno na stopu zanoÅ”enja poÅ”to funkcija kontralateralnog jajnika ostaje normalna.Ovarian reserve is defined as the number of oocytes in the ovary that are available for folliculogenesis. Determining ovarian reserve is important in evaluating and treating infertility, as well as in predicting the outcomes of assisting reproduction methods. There is no test available today that could directly measure number of oocytes. Therefore, in order to estimate the ovarian reserve different tests are being used, including measuring levels of hormones and knowing the physiological grounds for reproduction. Test used in determining the ovarian reserve can be divided in two groups, passive and dynamic. Passive tests include measuring serume levels of FSH, oestradiol, AMH, inhibin-B as well as measuring AFC, ovarian volume and ovarian vascularisation. Dynamic tests are clomiphene citrate challenge test, egsogeneous FSH test and gonadotrophins challenge test. As neither one of this methods is considered to be ideal, the best way to determine ovarian reserve is to combine them. Endometrioma is a benigb, oestrogen dependant cyst, which is strongly related to infertility and to diminished ovarian reserve. There are several suggested mechanisms to explain that correlation, the most significant being damage of the ovary caused by the presence of the endometrioma itself and removal of healthy ovarian tissue during surgery. Many diagnostic methods are being used to determine the presence of endomerioma, but the only confirmation is the pathohistological one. No consensus has been reached regarding endometrioma treatment. However, laparoscopic surgery is the most common way to treat endometiroma. Many studies have shown that the ovarian reserve is undoubtedly diminished following endometrioma surgery. However, studies have also shown that pregnancy rates in such patients do not seem to be significantly lower which is mostly atributed to the normal fucntion of the contralateral ovary
JoÅ” jedno lice infekcije Epstein-Barrovim virusom: akutni akalkulozni kolecistitis s kolestazom u prethodno zdrave petogodiÅ”nje djevojÄice s primarnom infekcijom
Acute acalculous cholecystitis (AAC) is a rare disease, particularly in children. The
clinical and laboratory presentation of AAC is variable. The diagnosis is based on radiological criteria.
AAC is an atypical and rare complication of Epstein-Barr virus (EBV) infection, therefore we present
a girl with AAC and cholestasis due to EBV primary infection. Conservative treatment and careful
monitoring was followed by clinical, radiological and laboratory improvement, and finally complete
recovery. Our aim was to highlight the importance of recognizing AAC as a differential diagnosis in
children with abdominal pain and/or acute cholestasis.Akutni akalkulozni kolecistitis (AAK) je rijetka bolest, osobito u djece. KliniÄka i laboratorijska slika AAK-a je raznolika,
a dijagnoza se temelji na radioloÅ”kim kriterijima. AAK je atipiÄna i rijetka komplikacija infekcije Epstein-Barrovim virusom
(EBV). Prikazujemo djevojÄicu s AAK i kolestazom posljediÄno primarnoj infekciji EBV-om. Konzervativno lijeÄenje praÄeno
je kliniÄkim, radioloÅ”kim i laboratorijskim poboljÅ”anjem te na koncu potpunim oporavkom djevojÄice. Cilj ovoga prikaza
je naglasiti važnost prepoznavanja AAK-a kao diferencijalne dijagnoze u djece s bolovima u trbuhu i/ili akutnom kolestazom
Cardiovascular risk in children and adolescents with restrictive type of anorexia nervosa
Anoreksija nervoza (AN) jedan je od poremeÄaja jedenja koji danas spada meÄu najÄeÅ”Äe kroniÄne bolesti adolescenata s visokom stopom smrtnosti, a najÄeÅ”Äe se veže za ženski spol i adolescentsku dob. Retrospektivna studija obuhvatila je 183 djevojÄice i adolescentice (od 2005. do 2015. godine) Centra za poremeÄaje u jedenju djece i adolescenata KliniÄkog bolniÄkog centra Sestre milosrdnice Zagreb. ProsjeÄna dob pacijentica bila je 14,8 Ā± 2,5 godina (7 do 23 godine) s dijagnozom AN u trajanju od prosjeÄno 12,8 Ā± 13,9 mjeseci (0,7 do 108 mjeseci). ProsjeÄni indeks tjelesne mase (BMI) je bio 15,8 Ā± 1,9 kg/m2 s postotkom idealne tjelesne mase (IBW) 77,7 Ā± 9,9 % i prosjeÄnim gubitkom na masi 21,7 Ā± 9,9 %. Normalan menstrualni ciklus je bio prisutan kod 20,6 %, a sekundarnu amenoreju je imalo 74,4 % AN pacijentica. PoveÄan kardiovaskularni (CVD) rizik utvrÄen je kod treÄine AN pacijentica (35,5 %) i gotovo polovice restriktivnog tipa AN (47,4 %). PoveÄan kardiovaskularni rizik kod AN pacijentica povezan je s loÅ”ijim antropoloÅ”kim parametrima (p=0,018) i amenorejom (p<0,001). Rezultati potvrÄuju povezanost poveÄanog CVD rizika i endotipa AN te potvrÄuju važnost tjelesnog oporavka kod AN pacijenata.Anorexia nervosa (AN), one of the eating disorders that today represents one of the most common chronic disease in adolescents with high mortality rate, is mainly related to female gender and adolescent age. The research was conducted in collaboration with the Centre for eating disorders in children and adolescents, Sestre milosrdnice University Hospital Center Zagreb. Observational retrospective study included 183 girls and adolescents from the Centre's registry (2005 to 2015 period). The average age of patients was 14.8 Ā± 2.5 years (7 to 21 years), with AN diagnosed for an average of 12.8 Ā± 13.9 months (0.7 to 108 months). Their average BMI was 15.8 Ā± 1.9 kg/m2 with IBW of 77.7 Ā± 9.9% and average weight loss of 21.7 Ā± 9.9%. Normal menstrual cycle was found in 20.6% patients and secondary amenorrhea in 74.4% of AN patients. The increased cardiovascular (CVD) risk was found in one third of AN patients (35.5%) and almost half in restrictive type AN patients (47.4%). The increased CVD risk correlates with worse anthropometric parameters (p=0.018) and amenorrhea (p<0.001). The results confirm correlation between the increased CVD risk and AN endotype and importance of nutritional recovery and normalization of the menstrual cycle as the main goal of AN treatment
Eosinophilic esophagitis ā what have we learned so far?
Eozinofilni ezofagitis (EoE) trenutno se definira kao kroniÄna, imunoloÅ”ki posredovana progresivna bolest jednjaka, obilježena eozinofilnom infiltracijom i kliniÄkim simptomima disfunkcije jednjaka. Nutritivni alergeni prema dosadaÅ”njim spoznajama imaju dominantnu ulogu u posredovanju imunoloÅ”ke reakcije. EoE je prvi puta opisan u literaturi krajem proÅ”log stoljeÄa, brojni dokazi potvrÄuju kako se radi o novom entitetu, a ne o boljem prepoznavanju bolesti. PrateÄi epidemioloÅ”ke trendove atopije opÄenito, bilježi se znaÄajan porast uÄestalosti broja oboljelih kod kojih Äesto postoji osobna ili obiteljska anamneza atopijskih poremeÄaja, poput astme, ekcema, rinitisa i anafilaksije na hranu. EoE se može javiti u bilo kojoj dobi, veÄ od dojenaÄkog perioda. KliniÄka prezentacija podrazumijeva Äitav spektar dobno uvjetovanih simptoma i znakova zahvaÄanja probavne cijevi. NelijeÄena bolest dovodi do trajnih oÅ”teÄenja funkcije jednjaka, vezivnog pretvaranja tkiva s posljediÄnom stenozom. DijagnostiÄki i terapijski pristup doživio je brojne i znaÄajne izmjene, no temelj potvrde dijagnoze ostaje histoloÅ”ka analiza sluznice jednjaka. Za sada ne postoji valjani biomarker koji bi mogao zamijeniti biopsiju i omoguÄiti
neinvazivno praÄenje bolesnika. Stoga jedan od najveÄih izazova u lijeÄenju djece i adolescenata s EoE, predstavlja veliki broj endoskopija nužnih za procjenu aktivnosti bolesti. U pedijatrijskih bolesnika koriste se razliÄite moguÄnosti lijeÄenja; farmakoterapija inhibitorima protonske pumpe i topiÄkim kortikosteroidima, dijetoterapija, te endoskopska dilatacija kod stenoze. Recentne smjernice razmatraju eozinofiliju jednjaka koja reagira na inhibitore protonske pumpe kao dio spektra EoE, a potonje pozicioniraju u prvu liniju lijeÄenja. UnatoÄ dramatiÄnom napretku razumijevanja patogeneze i evolucije bolesti u relativno kratkom vremenu od prvog opisa EoE pred tri desetljeÄa, mnoga otvorena pitanja ostaju nerazjaÅ”njena.Eosinophilic esophagitis (EoE) is currently defined as a chronic, immune-mediated progressive disease of the oesophagus, characterized by eosinophilic infiltration and symptoms of oesophageal dysfunction. Food-based allergens have a dominant role in mediating the immune response. It is a new entity, first described in the literature at the end of the last century. The scientists confirmed that EoE is a new phenomenon and not a better recognition due to new diagnostic methods. Following the atopy epidemiological trends in general, there is a significant increase in EoE incidence. Patients often have a personal or family history of atopic disorders, such as asthma, eczema, rhinitis, and food anaphylaxis. EoE can occur at any age, with different age-dependent clinical manifestations. Untreated disease leads to permanent damage of the esophageal function, connective tissue
transformation with consequent stenosis. The diagnostic and therapeutic approach has undergone numerous and significant changes, but the basis for confirming EoE remain histological analysis of the oesophageal mucosa. Still, there is no valid biomarker that could replace oesophageal biopsy and thus allow non-invasive methods to monitor patients. Therefore, one of the biggest challenges in the treatment of children and adolescents is the large
number of endoscopies necessary to monitor disease activity. Various treatment options have been used in paediatric patients, including proton pump inhibitors, elimination diets, ingested topical steroids, and endoscopic dilatations. More recently, oesophageal eosinophilia that responds to a proton pump inhibitor and EoE have been considered as part of the same spectrum, and proton pump inhibitors are considered the first line in the treatment.
Despite dramatic advances in understanding the pathogenesis and evolution of disease in the relatively short period of time since the discovery and first description of EoE three decades ago, many open questions remain unresolved
Karakteristike kontinuiranog mjerenja arterijskog tlaka u djece i adolescenata s esencijalnom hipertenzijom ovisno o tjelesnoj masi
Uvod: Arterijska hipertenzija i debljina kod djece su u
stalnom porastu i meÄusobno su povezane. Postoje
studije koje pokazuju razlike u karakteristikama kontinuiranog
mjerenja arterijskog tlaka (KMAT) u smislu
nepovoljnih nalaza u normotenzivne djece ovisno o indeksu
tjelesne mase (ITM), Å”to poveÄava kardiovaskularni
rizik.
Cilj: Analizirati postoje li razlike u karakteristikama
KMAT-a ovisno o ITM kod djece i adolescenata sa dijagnosticiranom
esencijalnom hipertenzijom.
Materijali i metode: Retrospektivno su analizirani podaci
132-oje pacijenata sa esencijalnom hipertenzijom u
dobi od 10 do 18 godina; podijeljenih u tri grupe ovisno
o ITM u one sa normalnom tjelesnom masom (ITM
<85.c. za dob i spol), prekomjernom tjelesnom masom
(ITM 85-95.c. za dob i spol) i pretile (ITMā„95.c. za dob i
spol). Svima je raÄeno KMAT-a i analizirane su kliniÄke
znaÄajke ispitanika. Za statistiÄku analizu koriÅ”teni su
F-test jednolikosti varijanci te T-test dva uzorka nejednakih
varijacija i za sve rezultate statistiÄka znaÄajnost
je odreÄena kao P<0,05.
Rezultati: Nije utvrÄena statistiÄki znaÄajna razlika u
prosjeÄnim vrijednostima sistole i dijastole, prosjeÄnim
vrijednostima dijastole i sistole danju i noÄu, tlaku pulsa,
prosjeÄnoj vrijednosti pulsa u 24 h, te postotku neopadajuÄeg
(eng. non diper) obrasca ovisno o ITM.
ZakljuÄak: Rezultati ne pokazuju statistiÄki znaÄajne
razlike u parametrima mjerenim KMAT-om kod djece i
adolescenata sa esencijalnom hipertnezijom, Å”to upuÄuje
na moguÄi združeni utjecaj genetskih, okoliÅ”nih
faktora i debljine na krvni tlak kod djece i adolescenata
sa esencijalnom hipertenzijom. Preporuka su nefarmakoloŔke
mjere kako u prevenciji, tako i lijeÄenju
hipertenzije kod djece i adolescenata, koje ukljuÄuju
prehrambene navike i naÄin života
Tranzitorni pseudohipoaldosteronizam sekundarno infekciji mokraÄnog sustava u muÅ”kog dojenÄeta s unilateralnom hidronefrozom i primarnim opstruktivnim megaureterom: prikaz sluÄaja
We present a case of transient form of type 1 pseudohypoaldosteronism (S-PHA)
in a 1.5-month-old male infant who presented with lethargy, failure to thrive, severe hyponatremia
(Na=118 mmol/L), hypochloremia (Cl=93 mmol/L) and fever due to urinary tract infection. Potassium
levels were normal. Markedly elevated serum aldosterone level and elevated serum renin confirmed
the diagnosis of pseudohypoaldosteronism. Renal ultrasound showed grade III hydronephrosis
on the left kidney while contrast-enhanced voiding urosonography excluded the existence of vesicoureteral
reflux, which raised suspicion of obstructive uropathy at the level of vesicoureteral junction.
Serum sodium normalized after several days of intravenous fluids and antibiotic therapy, after which
oral supplementation of sodium was introduced. The levels of 17-hydroxyprogesterone, adrenocorticotropic
hormone, cortisol and thyroid-stimulating hormone were normal. Functional magnetic resonance
urography conducted at the age of 3 months confirmed the diagnosis of primary congenital
obstructive megaureter and the infant was referred to a pediatric surgeon. Although a rare occurrence,
S-PHA can be a potentially life-threatening condition in infants if not recognized and treated appropriately.
Therefore, serum concentrations of electrolytes should be obtained in every child diagnosed
with obstructive anomaly of the urinary tract and/or acute cystopyelonephritis. On the other hand,
every child diagnosed with S-PHA should be evaluated for obstructive anomaly of the urinary tract.Prikazujemo sluÄaj tranzitornog oblika pseudohipoaldosteronizma tip 1 u muÅ”kog dojenÄeta u dobi od dobi mjesec i pol
koje se prezentiralo letargijom, nenapredovanjem na tjelesnoj masi, teŔkom hiponatremijom (Na=118 mmol/L), hipokloremijom
(Cl=93 mmol/L) te febrilitetom u sklopu akutne infekcije mokraÄnog sustava. Serumska razina kalija je bila uredna.
ZnaÄajno poviÅ”ene vrijednosti aldosterona i renina u plazmi potvrdile su dijagnozu pseudohipoaldosteronizma. Ultrazvukom
mokraÄnog trakta utvrÄena je hidronefroza III. stupnja lijevo, dok je mikcijskom urosonografijom pojaÄanom kontrastom
iskljuÄena prisutnost vezikoureteralnog refluksa te je postavljena sumnja na opstrukciju na razini vezikoureteralnog spoja.
Serumska razina natrija se normalizirala nakon nekoliko dana parenteralne rehidracije i antibiotske terapije, nakon Äega je
uvedena oralna suplementacija natrija. Razina 17-hidroksiprogesterona, ACTH, kortizola i TSH su bile uredne. U dobi
od 3 mjeseca uÄinjena je funkcionalna MR urografija koja je potvrdila dijagnozu primarnog kongenitalnog opstruktivnog
megauretera te je dojenÄe upuÄeno djeÄjem kirurgu. Iako rijedak, pseudohipoaldosteronizam je potencijalno životno ugrožavajuÄe
stanje ako nije na vrijeme prepoznato i primjereno zbrinuto. Sukladno tome, serumske koncentracije elektrolita treba
provjeriti kod svakog djeteta s poznatom opstruktivnom anomalijom mokraÄnog sustava i/ili cistopijeloneferitisom. S druge
strane, kod svakog djeteta s pseudohipoaldosteronizmom treba iskljuÄiti anomaliju mokraÄnog sustava
With food to health : proceedings of the 10th International scientific and professional conference
Proceedings contains 13 original scientific papers, 10 professional papers and 2 review papers which were presented at "10th International Scientific and Professional Conference WITH FOOD TO HEALTH", organised in following sections: Nutrition, Dietetics and diet therapy, Functional food and food supplemnents, Food safety, Food analysis, Production of safe food and food with added nutritional value
Education, regular check-ups and self-examinations as a prevetive methods for breast cancer
Rak dojke je zloÄudna bolest koja nastaje kad normalne žljezdane stanice dojke promjene
svoja svojstva te poÄnu nekontrolirano rasti, umnožavati se i uniÅ”tavati okolno zdravo tkivo.
Takve promijenjene stanice potom mogu otiÄi u limfne i/ili krvne žile te na taj naÄin proÅ”iriti
bolest u druge dijelove tijela. Rak dojke najÄeÅ”Äi je rak u žena u svijetu te predstavlja velik
zdravstveno socijalni problem zemalja zapadne civilizacije. Prema statistikama, svaka Äe deseta
žena dobiti rak dojke tijekom života. Rak dojke Äini oko 30 % svih tumora u žena i uzrokuje 15
% smrti od raka. U Hrvatskoj se godiÅ”nje dijagnosticira oko 20000 novootkrivenih sluÄajeva, a
oko 800 žena umre. ToÄna etiologija raka dojke joÅ” uvijek nije sasvim poznata, ali smatra se da
je to multifaktorska bolest koja ovisi o interakciji vanjskih (okoliŔnih) i unutarnjih (genetskih,
metaboliÄkih i hormonskih). Od raka dojke najÄeÅ”Äe obolijevaju žene iznad 50-e godine života,
ali u najnovije vrijeme sve ÄeÅ”Äe obolijevaju i mlaÄe žene u 40-im, 30-im pa Äak i u 20-im
godinama života. MuÅ”karci takoÄer mogu oboljeti od raka dojke, ali puno rjeÄe. Samo 1 % svih
zabilježenih sluÄajeva raka dojke otpada na muÅ”karce. U dijagnostici raka dojke koristi se
samopregled dojki, kliniÄki pregled, ultrazvuÄni pregled i mamografija, a konaÄna dijagnoza se
postavlja patoloÅ”kim pregledom uzorka tkiva dojke. U lijeÄenju raka dojke koristi se nekoliko
metoda, a to su: radioterapija odnosno zraÄenje, kirurÅ”ki zahvat, hormonska terapija i
imunoterapija te kemoterapija. Od trenutka postavljanja dijagnoze pa preko svih oblika lijeÄenja
i na kraju oporavka, provodi se rehabilitacija. Nakon zavrÅ”etka lijeÄenja, potrebno je
kontinuirano kontrolirati bolesnicu te pažnju usmjeriti na otkrivanje moguÄeg recidiva. Å to se
tiÄe programa rehabilitacije, on je individualan za svaku osobu. S obzirom da se u svijetu, pa
tako i u Hrvatskoj svake godine poveÄava broj novooboljelih žena, rak dojke postaje sve veÄi
javnozdravstveni problem. Dobrom organizacijom edukacija, osnivanjem grupa potpore ženama,
razliÄitim klubovima i projektima, moguÄe je u Å”to veÄem broju pravovremeno otkriti sumnjive
tvorbe na dojkama. Na taj naÄin oboljele žene mogu u kraÄem roku biti u procesu lijeÄenja koje
im može spasiti život.Breast cancer is a malignant disease that occurs when normal glandural cells change their
characteristics and begin to grow uncontrollably, multiply and destroy the surrounding healthy
tissue. Such changed cells can spread into the lymphatic and/or blood vessels and thus spread the
disease to other parts of the body. Breast cancer is the most common cancer that affects women
in the world and represents a major health problem of Western civilization. According to
statistics, every tenth women is diagnosed with breast cancer during their lifetime. Breast cancer
represents about 30% of all cancers in women and causes 15% of cancer deaths. About 20,000
newly discovered cases are diagnosed annually in Croatia, and around 800 women die. The exact
etiology of breast cancer is still not quite known, but it is considered to be a multifactorial
disease that depends on the interaction of external and internal (genetic, metabolic and
hormonal) factors. Breast cancer most commonly affects women over the age of 50, but
nowadays more often younger women in the early 40ās, 30ās and even 20ās are affected. Men
could also be affected by breast cancer, but rarely. Only 1% of all reported cases of breast cancer
are menās. Breast self-exam, clinical examination, ultrasound examination and mammography
are used to diagnose breast cancer, but final diagnosis is confirmed with pathological
examination of the breast tissue sample.In the treatment of breast cancer, several methods are
used: radiotherapy and irradiation, surgery, hormone therapy and immunotherapyor
chemotherapy. Rehabilitation is maintainedfrom the moment of diagnosis, through all forms of
treatment till the moment of full recovery. Once the treatment is complete, it is necessary to
continuously control the disease and watch for possible recurrence. The rehabilitation program is
individual for every person. Considering that the number of women diagnosed with cancer
increases in the world and in Croatia every year, breast cancer is becoming increasingpublic
health problem. With a good education organization, establishing womenās support groups,
different clubs and projects, it is possible to detect suspicious breast formations in as many cases
as possible. Thereby,affectedwomen couldfaster be included in a process of treatment that can
save their lives
Ovarian reserve before and after endometrioma surgery
Ovarijska rezerva je konaÄan broj jajnih stanica prisutnih u ovariju koje su dostupne za folikulogenezu. Procjena ovarijske rezerve bitna je u evaluaciji i lijeÄenju neplodnosti, te u predviÄanju ishoda metoda medicinske oplodnje. Kako nijedan test danas dostupan ne mjeri direktno ukupan broj oocita, procjena se vrÅ”i posredno mjerenjem ovarijskih hormona i poznavanjem fizioloÅ”ke osnove reprodukcije. Testove za mjerenje ovarijske rezerve možemo podijeliti na pasivne i dinamiÄke. Pasivni ukljuÄuju mjerenje serumskih koncentracija FSH, estradiola, AMH, inhibina-B, mjerenje broja antralnih folikula, te odreÄivanje volumena i vaskularizacije ovarija. U dinamiÄke testove ubrajamo provokacijski test klomifen citratom, egzogeni FSH test te provokacijski test gonadotropinima. Kako niti jedna od ovih metoda nije idealna, najbolji uvid u ovarijsku rezervu dobivamo kombinacijom nekoliko njih. Endometriom je benigna, o estrogenu ovisna ovarijska cista, koja je usko povezana s neplodnoÅ”Äu i sa smanjenom ovarijskom rezervom. Pretpostavljenih mehanizama te povezanosti ima nekoliko meÄu kojima su najznaÄajniji oÅ”teÄenje jajnika samom prisutnoÅ”Äu endometrioma i smanjenje ovarijske rezerve tijekom operacije uslijed uklanjanja zdravog tkiva ovarija koje se nalazi u okolini ciste. Mnogo je dijagnostiÄkih metoda pomoÄu kojih možemo utvrditi prisutnost endometrioma s velikom vjerojatno, ali jedina sigurna dijagnoza je patohistoloÅ”ki nalaz. Nema konsenzusa po pitanju naÄina lijeÄenja endometrioma, iako se danas u pravilu najÄeÅ”Äe pristupa laparoskopskoj operaciji. Mnoge studije su pokazale kako je ovarijska rezerva neupitno smanjena nakon operacije endometrioma iako prema dosadaÅ”njim saznanjima to ne utjeÄe drastiÄno na stopu zanoÅ”enja poÅ”to funkcija kontralateralnog jajnika ostaje normalna.Ovarian reserve is defined as the number of oocytes in the ovary that are available for folliculogenesis. Determining ovarian reserve is important in evaluating and treating infertility, as well as in predicting the outcomes of assisting reproduction methods. There is no test available today that could directly measure number of oocytes. Therefore, in order to estimate the ovarian reserve different tests are being used, including measuring levels of hormones and knowing the physiological grounds for reproduction. Test used in determining the ovarian reserve can be divided in two groups, passive and dynamic. Passive tests include measuring serume levels of FSH, oestradiol, AMH, inhibin-B as well as measuring AFC, ovarian volume and ovarian vascularisation. Dynamic tests are clomiphene citrate challenge test, egsogeneous FSH test and gonadotrophins challenge test. As neither one of this methods is considered to be ideal, the best way to determine ovarian reserve is to combine them. Endometrioma is a benigb, oestrogen dependant cyst, which is strongly related to infertility and to diminished ovarian reserve. There are several suggested mechanisms to explain that correlation, the most significant being damage of the ovary caused by the presence of the endometrioma itself and removal of healthy ovarian tissue during surgery. Many diagnostic methods are being used to determine the presence of endomerioma, but the only confirmation is the pathohistological one. No consensus has been reached regarding endometrioma treatment. However, laparoscopic surgery is the most common way to treat endometiroma. Many studies have shown that the ovarian reserve is undoubtedly diminished following endometrioma surgery. However, studies have also shown that pregnancy rates in such patients do not seem to be significantly lower which is mostly atributed to the normal fucntion of the contralateral ovary