Distrofična bulozna epidermoliza s kožnim karcinomom – utjecaj na anesteziju – prikaz slučaja

We report a patient with recessive dystrophic epidermolysis bullosa who developed multiple skin cancer on the upper arm. She was scheduled for arm amputation. Skin and mucosa lesions render more difficulty in anesthetic management, especially monitoring, positioning and airway instrumentation. General anesthesia based on ketamine enables us to avoid some of the problems.Opisujemo bolesnicu s distrofičnim oblikom buloznog dermatitisa u koje su se razvili multipli kožni karcinomi nadlaktice. Bolesnica je predviđena za amputaciju ruke. Kožne promjene i promjene sluznice otežavaju vođenje anestezije, a osobito promatranje, namještanje i pristup dišnom putu. Opća anestezija ketaminom omogućila nam je da izbjegnemoneke od navedenih problema

Distrofična bulozna epidermoliza s kožnim karcinomom – utjecaj na anesteziju – prikaz slučaja

We report a patient with recessive dystrophic epidermolysis bullosa who developed multiple skin cancer on the upper arm. She was scheduled for arm amputation. Skin and mucosa lesions render more difficulty in anesthetic management, especially monitoring, positioning and airway instrumentation. General anesthesia based on ketamine enables us to avoid some of the problems.Opisujemo bolesnicu s distrofičnim oblikom buloznog dermatitisa u koje su se razvili multipli kožni karcinomi nadlaktice. Bolesnica je predviđena za amputaciju ruke. Kožne promjene i promjene sluznice otežavaju vođenje anestezije, a osobito promatranje, namještanje i pristup dišnom putu. Opća anestezija ketaminom omogućila nam je da izbjegnemoneke od navedenih problema

Writing letters to patients as an educational tool for medical students

BACKGROUND: Despite rapid growth and development of medical technology, personal relationship between the patient and physician remains the basis of high quality treatment. The aim of our study was to develop, implement and evaluate patient therapeutic letters written by students as a tool in teaching family medicine. METHODS: The study included all 6(th) year students attending their rounds in family medicine, structured into two 10-day cycles, one in urban offices and one in offices on the Adriatic islands (rural). After receiving detailed instructions, students wrote letters to two patients after a consultation in the office. The letters were audited by patients and 3 family medicine experts who used a grading instrument (scale 0 – poor, 1 – medium, 2 – good) for 1) adequacy and clarity of description of patients’ disease/state, 2) knowledge, 3) adequacy of recommendations, 4) courtesy and respect and 5) language and style. Patients and experts were also asked to underline phrases they thought would be difficult to understand; the underlined text was subjected to content analysis. RESULTS: Both the patients and the experts gave high scores for the value and quality of the letters in terms of the description of the problem, adequacy of recommendations given, and courtesy and respect (mean (±standard deviation) 5.65 ± 0.79 for patients vs. 4.87 ± 0.79 for experts out of maximum score of 6). Family medicine experts were stricter than patients in their evaluation of the content of the letters (adequacy and clarity of disease description (P < 0.001) and adequacy of recommendations (P < 0.001). Both the patients and the experts seemed to like longer letters as the length of the letter showed significant positive correlation with the quality summary score (correlation r = 0.492 vs. r = 0.338, respectively, P < 0.010). Overlapping of the text underlined as difficult to understand by patients and experts was found in 10 (11.6%) out of 86 letters. The highest overlap (20 terms) was found for the category “Technical terms unclear to a lay reader”. CONCLUSIONS: Writing of a letter to their first patients may be a useful tool for students to personally experience the practice of medicine and establish better partnership with patients in health care

Diagnosis and treatment of mammary glands neoplasia in cats

Tumori mliječne žlijezde mačaka su po učestalosti na trećem mjestu, s malignitetom od 80 do 90%. Tumori mliječne žlijezde su agresivni, brzo rastu i metastaziraju u regionalne limfne čvorove, pluća, jetru i slezenu. Nakon kirurškog liječenja česti su recidivi. Najvažniji prognostički čimbenici u procijeni vremena bez znakova bolesti i vremena preživljavanja nakon operacije su veličina, obujam tumora i tip operacije. Što je tumor manji prognoza je bolja. Pretpostavlja se da spolni hormoni imaju važnu ulogu u nastanku tumora, dok rana kastracija znatno smanjuje rizik od nastanka tumora. Uporaba progestina povećava rizik od nastanka bolesti. Radikalna unilateralna ili bilateralna mastektomija je preporučeno kirurško liječenje. Kirurško liječenje u kombinaciji s kemoterapijom u uznapredovalim slučajevima pruža puno bolju prognozu. Ključne riječiMammary neoplasia in cats rank third in frequency, with a malignancy rate of 80-90%. Mammary tumours are aggressive, grow rapidly and metastasize to regional lymph nodes, lung, liver and spleen. After surgical treatment, relapses are common. The most important prognostic factors to estimate the time and disease-free survival time after surgery include the size and volume of the tumour, and the type of operation. The smaller the tumour, the better the prognosis. It is assumed that sex hormones play a role in tumour formation. Early castration significantly reduces the risk of cancer, while the use of progestin increases the risk of disease. Radical unilateral or bilateral mastectomy is the recommended surgical treatment. In advanced cases, surgical treatment in combination with chemotherapy significantly improves the prognosis

Diagnosis and treatment of mammary glands neoplasia in cats

Tumori mliječne žlijezde mačaka su po učestalosti na trećem mjestu, s malignitetom od 80 do 90%. Tumori mliječne žlijezde su agresivni, brzo rastu i metastaziraju u regionalne limfne čvorove, pluća, jetru i slezenu. Nakon kirurškog liječenja česti su recidivi. Najvažniji prognostički čimbenici u procijeni vremena bez znakova bolesti i vremena preživljavanja nakon operacije su veličina, obujam tumora i tip operacije. Što je tumor manji prognoza je bolja. Pretpostavlja se da spolni hormoni imaju važnu ulogu u nastanku tumora, dok rana kastracija znatno smanjuje rizik od nastanka tumora. Uporaba progestina povećava rizik od nastanka bolesti. Radikalna unilateralna ili bilateralna mastektomija je preporučeno kirurško liječenje. Kirurško liječenje u kombinaciji s kemoterapijom u uznapredovalim slučajevima pruža puno bolju prognozu. Ključne riječiMammary neoplasia in cats rank third in frequency, with a malignancy rate of 80-90%. Mammary tumours are aggressive, grow rapidly and metastasize to regional lymph nodes, lung, liver and spleen. After surgical treatment, relapses are common. The most important prognostic factors to estimate the time and disease-free survival time after surgery include the size and volume of the tumour, and the type of operation. The smaller the tumour, the better the prognosis. It is assumed that sex hormones play a role in tumour formation. Early castration significantly reduces the risk of cancer, while the use of progestin increases the risk of disease. Radical unilateral or bilateral mastectomy is the recommended surgical treatment. In advanced cases, surgical treatment in combination with chemotherapy significantly improves the prognosis

The influence of smoking and parity on serum markers for Down's syndrome screening

Objective: To evaluate the impact of smoking and number of previous births on maternal serum levels of α-fetoprotein and free β-subunit of human chorionic gonadotropin (free β-hCG). Methods: The study included 3,252 completed unaffected singleton pregnancies that proceeded beyond 37 weeks’ gestation and resulted with a birth of healthy child. Smoking status of mothers and data concerning gravidity and parity were collected at the sampling date. Serum markers were measured between 13 and 22 gestational weeks, corrected for maternal weight, and converted to multiples of median (MoM) for unaffected pregnancy of the corresponding gestational age. Median MoM values for both markers were examined in relation to both: smoking habits and number of previous births. Results: Smokers had significantly decreased free β-hCG MoM values compared to nonsmokers (p < 0.001). The median levels showed a negative relationship with the number of previous births. The significance of a decreasing trend was proved, both in smokers (p < 0.001) and nonsmokers (p < 0.001). The median maternal serum α-fetoprotein MoM values did not show any significant dependence, neither with regard to smoking (p = 0.65) nor with regard to parity (p = 0.07). Conclusions: The recommendable adjustment of serum markers to smoking habits, especially concerning the free β-hCG levels, would be worthwhile. The evidence of the coexisting influence of parity on serum levels of free β-hCG, both in smokers and nonsmokers, should perhaps be a stimulus for reconsideration of which corrections the screening performance is dependent on

Elevated Second-trimester Free beta-hCG as an Isolated Finding and Pregnancy Outcomes

Objective: To investigate the relationship between unexplained elevated second-trimester free β-human chorionic gonadotropin (β-hCG) levels and pregnancy complications as well as adverse pregnancy outcomes. Methods: The study cohort comprised 2,110 non-smoking women with chromosomal and structurally normal fetuses at low-risk for both Down’s syndrome (risk 0.05)

Flour - Bread '19 : Proceedings of the 10th International Congress Flour - Bread '19 and 12th Croatian Congress of Cereal Technologists Brašno - Kruh '19

Proceedings contains 3 Reviews, 8 Original research articles and 3 Professional articles presented at 10th International Congress Flour – Bread ’19 and 12th Croatian Congress of Cereal Technologists Brašno – Kruh ’1