Smernice za obravnavo bolnic z rakom materničnega vratu v Sloveniji: povzetek

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Kirurško zdravljenje akutnega izpaha pogačice s kostnim odlomkom pri otrocih

Purpose: The management of acute patellar dislocation in children and adolescents is controversial. Traditionally,most first time traumatic patellar dislocations have been treated nonoperatively. However, due to new knowledge about medial patellar stabilizers some authors have advocated for surgical repair. The present report describes the midterm subjective and functional results of operative treatment of acute patellar dislocation in children less than eighteen years of age with concomitant osteochondral fracture. Methods: Data on a cohort of sixteen patients (eight girls and eight boys) aged 14.9 years (mean, range12-17 years) with acute patellar dislocation were retrospectively collected. Intraarticular fragments were detected in all patients in conventional radiographs. Operative treatment consisted of arthroscopic removal (12cases) or refixation (4 cases) of the osteochondral fragments and direct repair of the damaged medial patellofemoral ligament (MPFL) if that was still feasible (13 cases). All patients were seen at six months, and a telephone interview with twelve patients (75%) was conductedat four years (mean, range 27 years). Results: Of the sixteen patients, two (12.5%) had a recurrent patellar luxation. The subjective IKDC score at the time of the most recent follow up was 86 (mean, range 63-100), and the Marx Activity Rating Scale score was 9.2 (mean, range 216).Conclusions: Direct surgical repair of the injured MPFLmay be considered an option to prevent subsequent dislocation and subluxation in first time traumatic dislocation of the patella in children and adolescents with osteochondral fractures and substantial disruption of medial patellar stabilizers.Namen: O zdravljenju akutnega izpaha pogačice pri otrocih in mladostnikih še ni jasnega konsenza. Tradicionalno zdravljenje prvega poškodbenega izpaha pogačice je bilo konzervativno, zaradi novih spoznanj o medialnih stabilizatorjih pogačice pa nekateri avtorji v zadnjem času priporočajo operacijsko zdravljenje. Pričujoča raziskava opisuje srednjeročne subjektivne in funkcionalne rezultate operacijskega zdravljenja akutnega izpaha pogačice s pridruženim osteohondralnim odlomkom pri otrocih in mladostnikih, mlajših od osemnajst let. Metode: Retrospektivno smo zbrali podatke 16 bolnikov (osmih deklic in osmih dečkov), povprečno starih 14,9 (12-17) let z akutnim izpahom pogačice. Pri vseh bolnikih smo na rentgenskih posnetkih ugotovili prisotnost znotrajsklepnih odlomkov. Bolnike smo operacijsko zdravili z artroskopsko odstranitvijo (12 primerov) ali refiksacijo (4 primeri) osteohondralnih odlomkov in neposrednim popravilom medialne patelofemoralne vezi, kjer je bilo to še mogoče (13 primerov). Bolnike smo pregledali po šestih mesecih in z dvanajstimi (75 %) opravili telefonski pogovor po povprečno štirih (2-7) letih. Rezultati: Dva izmed 16 bolnikov (12,5 %) sta imela ponovni izpah pogačice. Povprečno doseženo število točk po subjektivnem IKDC točkovniku ob zadnjem sledenju je bilo 86 (63-100), po Marx Activity Rating Scale pa 9,2 (216). Zaključki: Neposredna kirurška rekonstrukcija medialne patelofemoralne vezi predstavlja možnost preprečitve ponovne dislokacije in subluksacije pogačice. Posebej primerna je lahko ob prvem travmatskem izpahu pogačice pri otrocih in mladostnikih z osteohondralnimi zlomi in obsežnejšo okvaro medialnih stabilizatorjev pogačice

The Association of Vitamin D Levels with Common Pregnancy Complications

The association between vitamin D deficiency and various adverse pregnancy outcomes has been extensively investigated in recent years. The pregnant woman is the only source of vitamin D for the foetus. The main sources of vitamin D for pregnant women are sunlight, fortified dairy products, oily fish and dietary supplements. Vitamin D deficiency during pregnancy has been associated with some adverse neonatal outcomes as well as an increased risk of late pregnancy complications. The outcomes of the published studies investigating preeclampsia and gestational diabetes mellitus vary with some large trials suggesting a potential positive effect of vitamin D supplementation during pregnancy on the decreased risk of these complications. Research also suggests a possible connection between lower vitamin D concentrations and increased risk of preterm labour. In our manuscript, we aim to review the existing literature regarding the prevalence of vitamin D deficiency during pregnancy, the factors associated with vitamin D deficiency, and possible pregnancy complications arising from it

Seasonal variations of vitamin D concentrations in pregnant women and neonates in Slovenia

Izhodišča: Vitamin D je v maščobah topen vitamin, katerega pomanjkanje v nosečnosti povezujejo z različnimi zapleti v nosečnosti in boleznimi pri novorojenčku. V mariborski regiji še ni bilo raziskave, ki bi ugotavljala koncentracijo vitamina D pri nosečnicah in novorojenčkih. Namen raziskave je bil ugotoviti povprečne koncentracije vitamina D pri nosečnicah in novorojenčkih, pogostnost pomanjkanja vitamina D, dejavnike, ki vplivajo na koncentracjo vitamina D pri nosečnicah in novorojenčkih, in vpliv koncentracije vitamina D na pojav zapletov pri nosečnici in novorojenčku. Bolniki in metode: Opravili smo prospektivno opazovalno raziskavo na 400 nosečnicah in njihovih novorojenčkih v štirih različnih letnih časih. Izbrani meseci so bili na koncu vsakega izmed letnih časov. Mesec september je predstavljal poletno skupino, december jesensko, marec zimsko in junij pomladno skupino. V raziskavo smo vključili nosečnice kavkazijske rase, ki so živele na širšem področju Maribora in so podpisale osveščen pristanek. Iz anketnih vprašalnikov smo pridobili podatke o prehrani in izpostavljenosti soncu v nosečnosti. Iz zdravstvene dokumentacije smo pridobili podatke o zdravstvenem stanju nosečnice pred in med nosečnostjo, podatke o zapletih v nosečnosti in načinu poroda ter podatke o zdravstvenem stanju novorojenčka. Vzorec krvi nosečnice smo odvzeli tekom hospitalizacije, vendar ne kasneje kot dva dni po porodu. Odvzem vzorca krvi iz popkovnice smo opravili takoj po prekinitvi popkovnice po porodu. Koncentracije vitamina D smo razdelili glede na priporočila iz literature: > 80 nmol/L – zadostne koncentracije, 50‒80 nmol/L – nezadostne koncentracije, 25‒50 nmol/L – pomanjkanje in < 25 nmol/L – hudo pomanjkanje vitamina D. Rezultati: Povprečna koncentracija vitamina D pri nosečnicah v vseh štirih skupinah je bila 43,7 ± 23,8 nmol/L. 23,6 % nosečnic je imelo hudo pomanjkanje vitamina D, 41,5 % jih je imelo pomanjkanje vitamina D, 27,9 % jih je imelo nezadostne koncentracije vitamina D. Zadostne koncentracije vitamina D smo izmerili pri 7,0 % nosečnic. Povprečna koncentracija vitamina D pri novorojenčkih je bila 55,2 ± 30,9 nmol/L. Pri analizi vpliva posameznih dejavnikov na koncentracijo vitamina D pri nosečnicah so se kot pomembni pokazali letni čas (F = 33,979p < 0,001), trajanje sončnega obsevanja 30 dni pred porodom (r = 0,371, p < 0,001), povprečna temperatura 30 dni pred porodom (r = 0,401, p < 0,001), uživanje rib (t = 2,183p = 0,030), količina rib na obrok (F = 3,131p = 0,026), uživanje prehranskih nadomestkov z dodanim vitaminom D (t = ‒4,271p < 0,001), pogostnost sončenja (F = 3,144p = 0,025) in trajanje ene epizode sončenja (F = 3,719p = 0,012). Izmed omenjenih dejavnikov sta v multivariatni analizi statistično značilnost ohranila trajanje ene epizode sončenja (β = 0,185p = 0,031) in jemanje prehranskih nadomestkov z dodanim vitaminom D (β = ‒0,098p < 0,001). Nosečnice, ki so rodile prezgodaj (t = 2,296p = 0,022), in tiste, ki so rodile s carskim rezom (t=2,053p=0,041), so imele značilno nižje koncentracije vitamina D v primerjavi s kontrolami. Zaključki: Koncentracije vitamina D so bile pri veliki večini nosečnic v mariborski regiji nižje od priporočenih vrednosti. Paradoksalno so imeli novorojenčki višjo povprečno koncentracijo vitamina D kot nosečnice. V vseh štirih skupinah smo opažali močno pozitivno korelacijo med koncentracijami vitamina D pri materi in v popkovnični krvi. Med posameznimi letnimi časi smo ugotovili značilno razliko v koncentraciji vitamina D, pri čemer smo najvišje vrednosti ugotovili v junijski (pomladni) skupini, najnižje pa v marčevski (zimski)skupini. Koncentracija vitamina D je bila višja pri nosečnicah, ki so se v času nosečnosti več sončile, in pri tistih, ki so jemale prehranske nadomestke z vitaminom D.Introduction: Vitamin D is a lipid soluble vitamin. Its deficiency has been connected to various complications during pregnancy and neonatal complications. Vitamin D concentrations in pregnant women and neonates in the Maribor region have never been investigated. The main purpose of this study was to determine the average vitamine D concentrations in pregnant women at term and in their neonates, to determine the incidence of vitamin D deficiency, the factors influencing vitmain D concentrations, and possible connection between vitamin D concentrations and pregnancy and neonatal compliations. Materials and methods: A prospective observational study on 400 pregnant women at term and their neonates was conducted in four different seasons. The months at the end of each season were chosenas representative. September represented the summer group, December the autumn, March the winter and June the spring group. Caucasian women living in the Maribor area who signed an informed consent were included in the study. Participants were asked to fill in a questionnaire from which we obtained the information regarding the diet and sun exposure during pregnancy. Information about the health condition of each participant was obtained from hospital computer information system. Pregnancy complications and neonatal health condition were also analysed. The blood sample of pregnant women was obtained in the course of hospitalisation no later than two days after birth. The cord blood sample was obtained immediately after birth after umbillical cord clamping. Vitamin D concentrations were divided into groups according to the literature: >80 nmol/L – sufficient concentrations, 50‒80 nmol/L – insufficient concentrations, 25‒50 nmol/L – deficiency, and <25 nmol/L – severe deficiency. Results: The average vitamin D concentration in pregnant women in all four groups was 43.7±23.8 nmol/L. 23.6% of participants had severe vitamin D deficiency, 41.5% had vitamin D deficiency, and 27.9% had vitamin D insufficiency. Sufficient concentrations were present in 7.0%. The average neonatal vitamin D concentration was 55.2±30.9 nmol/L. In the analysis of various factors influencing maternal vitamin D concentrations, statistically significant associations were found with season (F=33.979p<0.001), average duration of sunshine 30 days before delivery (r=0.371, p<0.001), average temperature 30 days before delivery (r=0.401, p<0.001), fish consumption (t=2.183p=0.030), quantity of fish per meal (F=3.131p=0.026), use of nutritional supplements containing vitamin D (t=‒4.271p<0.001) frequency of sunbathing (F=3.144p=0.025), and the duration of one episode of sunbathing (F=3.719p=0.012). In multivariate analysis, statistical significance was retained for the intake of nutritional supplements containing vitamin D (β=‒0.098p<0.001) and the duration of one episode of sunbathing (β=0.185p=0.031). Women with preterm labor (t=2.296p=0.022) and with caesarean section(t=2.053p=0.041) had significantly lower vitamin D concentrations compared with controls. Conclusions: Maternal vitamin D concentrations in the Maribor region were much lower than the recommended values. Paradoxically, higher vitamin D concentrations were found in neonates than in their mothers. Marked seasonal variations were present with the highest vitamin D concentrations noted in the June (spring) group and the lowest in the March (winter) group. Vitamin D concentrations were higher in women who sunbathed for longer periods of time during pregnancy and in those who took nutritional supplements containing vitamin D

Zdravljenje materničnih sarkomov v Univerzitetnem kliničnem centru Maribor v obdobju 1996-2011

Purpose: Uterine sarcomas are rare malignant tumours with a worse prognosis than endometrial carcinomas.This retrospective study was performed to determine the clinical and histologic characteristics, treatment, and outcomes in uterine sarcoma patients treated at our hospital over a 16-year period. Methods: Twenty-two patients (median age, 60.5 years) with uterine sarcomas were treated at our facility between 1996 and 2011. Information was collected from hospital and follow-up records and from the Cancer Registry of Slovenia. All tumours were classified according to the new FIGO classification for uterine sarcomas. Results: The majority of the patients presented with postmenopausal bleeding. The most common histologic subtype was leiomyosarcoma (50%), followed by carcinosarcoma (40.9%), and endometrial stromal sarcoma (9.1%). All of the patients were initially treated surgically, 21 by laparotomy and 1 laparoscopically. Eight patients were treated with postoperativeradiotherapy and 4 patients received postoperativechemotherapy. Disease progression was observed in 8 of17 patients who had sufficient followup information forthis analysis. The 5-year overall survival was 44 %.Conclusion: The overall survival of patients treated for uterine sarcomas in our study was comparatively good. Due to the small number and heterogeneity of the patients, larger multicentre trials are needed for a reliable analysis of factors influencing patient survival.Namen: Maternični sarkomi so redki maligni tumorji s slabšo prognozo od endometrijskih karcinomov. Pričujoča retrospektivna študija predstavlja pregled kliničnih in histoloških značilnosti, zdravljenja in izida zdravljenja pri bolnicah, ki smo jih zaradi materničnih sarkomov zdravili v naši ustanovi v 16-letnem obdobju. Metode: V obdobju 1996-2011 smo v Univerzitetnem kliničnem centru Maribor zdravili 22 bolnic s sarkomom maternice (srednja starost 60,5 let). Podatke smo zbrali retrospektivno iz bolnišničnih in ambulantnih popisov ter iz Registra raka za Slovenijo. Vse tumorje smo klasificirali v skladu z novo FIGO klasifikacijo materničnih sarkomov. Rezultati: Večina bolnic je pred diagnozo navajala pomenopavzne krvavitve. Najpogostejši histološki podtip je bil leiomiosarkom (50 %), sledila sta mu karcinosarkom (40,9 %) in endometrijski stromalni sarkom (9,1 %). Vse bolnice smo primarno zdravili kirurško, od tega 21 z laparotomijo in eno laparoskopsko. 8 bolnic je prejemalo pooperativno radioterapijo, 4 so prejemale pooperativno kemoterapijo. Progres bolezni smo ugotovili pri 8 izmed 17 bolnic, za katere smo imeli zadostne podatke. 5-letno celokupno preživetje je bilo 44 %. Zaključek: Celokupno preživetje bolnic, zdravljenih zaradi sarkoma maternice, je v naši raziskavi relativno dobro. Zaradi majhnega števila bolnic in njihove heterogenosti bi bile za zanesljivo analizo dejavnikov, ki vplivajo na preživetje bolnic z materničnim sarkomom, potrebne večje multicentrične raziskave

Novosti v zdravljenju raka dojk in raka jajčnikov ASCO, Annual Meeting, Chicago, 1.-5. 6. 2012

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Smernice za obravnavo bolnic z rakom materničnega vratu v Sloveniji

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