Multimodalni pristup liječenju poslijeoperacijske mučnine i povraćanja (PONV)

The paper shows a new, multimodal approach to the prevention of postoperative nausea and vomiting (PONV), which are among the most common complications in surgically treated patients. The approach combines the following procedures: risk assessment of postoperative nausea and vomiting, minimization of adverse effects of anesthesia and surgery, prophylaxis using drugs with anti-emetic effect, and optimization of therapy in case the complication develops. Besides reducing the incidence rate of PONV, such approach also reduces both the number of PONV-related serious complications and treatment costs.Ovim radom prikazan je novi, multimodalni pristup prevenciji i liječenju postoperacijske mučnine i povraćanja (PONV, od engl. postoperative nausea and vomiting) jedne od najčešćih komplikacija koja se pojavljuje u operiranih bolesnika. Objedinjuje sljedeće postupke procjenu rizika za razvoj PONV-a, minimaliziranje nepovoljnih učinaka anestezije i operacijskog zahvata, preventivnu primjenu kombinacije lijekova sa antiemetskim učinkom kao i optimalizaciju terapije ako se komplikacija razvije. Ovom metodom, pored snižavanja učestalosti PONV- a, smanjujemo i broj ozbiljnih komplikacija ove pojave kao i troškove liječenja

Multimodalni pristup liječenju poslijeoperacijske mučnine i povraćanja (PONV)

The paper shows a new, multimodal approach to the prevention of postoperative nausea and vomiting (PONV), which are among the most common complications in surgically treated patients. The approach combines the following procedures: risk assessment of postoperative nausea and vomiting, minimization of adverse effects of anesthesia and surgery, prophylaxis using drugs with anti-emetic effect, and optimization of therapy in case the complication develops. Besides reducing the incidence rate of PONV, such approach also reduces both the number of PONV-related serious complications and treatment costs.Ovim radom prikazan je novi, multimodalni pristup prevenciji i liječenju postoperacijske mučnine i povraćanja (PONV, od engl. postoperative nausea and vomiting) jedne od najčešćih komplikacija koja se pojavljuje u operiranih bolesnika. Objedinjuje sljedeće postupke procjenu rizika za razvoj PONV-a, minimaliziranje nepovoljnih učinaka anestezije i operacijskog zahvata, preventivnu primjenu kombinacije lijekova sa antiemetskim učinkom kao i optimalizaciju terapije ako se komplikacija razvije. Ovom metodom, pored snižavanja učestalosti PONV- a, smanjujemo i broj ozbiljnih komplikacija ove pojave kao i troškove liječenja

Correlation between Land Use and Urban Public Transport: Case Study of Zagreb

Investment in the transport system with the aim of fostering attractiveness and land use in urban structures is of great interest for planners and investors. Investment in urban public transport would especially contribute to revitalising distinct city areas. The samples of high population density and diversified area use are organised around accessible means of urban public transport.The main objective of this case study was to find an adequate model for the solution of urban public transport on the location Novi Jelkovec in Zagreb after the construction of a new urban settlement, with the aim to revitalise the peripheral parts of the city. The theoretical assumption on the influence of better organised transport on land use is hereby researched through the example of correction of timetables and reduction of travelling time between nodes on the line in the Novi Jelkovec settlement. In preparing this paper the following methods were used: analysis and synthesis, mathematical and statistical methods, methods of interviewing. The theory of correlation of land use and urban public transport is based on models that develop the “compact city”. The obtained research results confirm the significance of the correlation between urban land use and urban public transport. It can be concluded that this paper proves the influence of the correlation between land use and urban public transport on the concrete example of Novi Jelkovec. Its implementation could result in solving the concrete traffic problem and along with it a faster urbanisation of the new settlement

Procjena rizika i prevencija plućnih komplikacijau perioperacijskom periodu

The incidence rate of pulmonary complications in the immediate postoperative period of non-cardiac surgery equals the incidence rate of cardiovascular complications. Patients undergoing surgery in the upper abdomen or any major abdominal operation are at the greatest risk. Exacerbation of chronic lung disease, respiratory failure, development of atelectasis and pneumonia are the most common and the most significant pulmonary complications in the early postoperative period. Patient’s health status, preoperative preparation and the type of surgery are the factors playing the leading role in the incidence of these complications. Prolonged hospitalization, increased treatment costs and longer recovery are additional significant issues requiring the routine introduction of procedures to reduce the incidence rate of perioperative pulmonary complications.Učestalost plućnih komplikacija u neposrednom poslijeoperacijskom periodu nakon nekardijalnih operacija jednaka je pojavnosti komplikacija od strane kardiovaskularnog sustava. Najvećem riziku izloženi su bolesnici nakon kirurških zahvata u gornjem abdomenu ili drugih velikih operacija u trbušnoj šupljini. Egzarcerbacija kronične plućne bolesti, respiratorna insuficijencija, razvoj atelektaza i posljedičnih pneumonija najčešće su i najznačajnije plućne komplikacije u ranom postoperacijskom periodu. Zdravstveni status bolesnika, prijeoperacijska priprema te vrsta kirurškog postupka glavni su čimbenici pojavnosti ovih komplikacija. Prolongiranje bolničkog liječenja, povećanje troškova i dugotrajniji oporavak su dodatni značajni problemi koji nam nameću potrebu za rutinskim uvođenjem postupaka kojim ćemo smanjiti učestalost plućnih komplikacija u perioperacijskom periodu

Procjena rizika i prevencija plućnih komplikacijau perioperacijskom periodu

The incidence rate of pulmonary complications in the immediate postoperative period of non-cardiac surgery equals the incidence rate of cardiovascular complications. Patients undergoing surgery in the upper abdomen or any major abdominal operation are at the greatest risk. Exacerbation of chronic lung disease, respiratory failure, development of atelectasis and pneumonia are the most common and the most significant pulmonary complications in the early postoperative period. Patient’s health status, preoperative preparation and the type of surgery are the factors playing the leading role in the incidence of these complications. Prolonged hospitalization, increased treatment costs and longer recovery are additional significant issues requiring the routine introduction of procedures to reduce the incidence rate of perioperative pulmonary complications.Učestalost plućnih komplikacija u neposrednom poslijeoperacijskom periodu nakon nekardijalnih operacija jednaka je pojavnosti komplikacija od strane kardiovaskularnog sustava. Najvećem riziku izloženi su bolesnici nakon kirurških zahvata u gornjem abdomenu ili drugih velikih operacija u trbušnoj šupljini. Egzarcerbacija kronične plućne bolesti, respiratorna insuficijencija, razvoj atelektaza i posljedičnih pneumonija najčešće su i najznačajnije plućne komplikacije u ranom postoperacijskom periodu. Zdravstveni status bolesnika, prijeoperacijska priprema te vrsta kirurškog postupka glavni su čimbenici pojavnosti ovih komplikacija. Prolongiranje bolničkog liječenja, povećanje troškova i dugotrajniji oporavak su dodatni značajni problemi koji nam nameću potrebu za rutinskim uvođenjem postupaka kojim ćemo smanjiti učestalost plućnih komplikacija u perioperacijskom periodu

Regional anaesthesia in cancer surgery: an update

Anaesthetic techniques can influence the cellular immune system and affect long term outcome. Cancer surgery itself and general anaesthetics, especially opioids, suppress immunity and therefore promote metastases. Regional anaesthesia attenuates the immunosuppressive effect of surgery. Local anaesthetics, contrary to opioids, stimulate the activity of natural killer (NK) cells during the perioperative period. All techniques of regional anaesthesia are very useful and applicable in cancer surgery, either for the anaesthesia itself or for the treatment of postoperative pain. The relationship between regional anaesthesia and cancer recurrence is one of the most interesting topics in anaesthesia today, but we must wait the results of prospective trials before definitive conclusions

Restructuring models for road traffic inspections in Republic of Croatia

Opseg aktivnosti Inspekcije cestovnog prometa u Hrvatskoj je s ulaskom u Europsku Uniju znatno povećan, prvenstveno zbog nadzora primjene socijalnog zakonodavstva u cestovnom prijevozu koje regulira područje radnih vremena mobilnih radnika, područje tahografa i tahografskih radionica te izdavanje memorijskih kartica za vozače, servisere i prijevoznike. Nameće se pitanje da li je Inspekcija cestovnog prometa u Republici Hrvatskoj ustrojena na pravi način te da li se postojećom organizacijom i načinom funkcioniranja mogu ispuniti sve postavljene zadaće. Stoga se u ovom radu primjenom znanstvenih metoda predlažu i analiziraju modeli mogućeg preustroja Inspekcije cestovnog prometa u Republici Hrvatskoj, prednosti i nedostaci predloženih modela te mogućnosti daljnjeg poboljšanja rada ove službe.The scope of activities of Road traffic inspection in Croatia was increased significantly by the accession to the European Union, primarily due to control of application of social legislation in road transport that regulates working time of mobile workers, the area of the tachographs and tachograph workshops and issuing of memory cards for drivers, service technicians and transporters. The question is whether the Road traffic inspection in the Republic of Croatia is organized in the right way and whether the existing organization and the functioning can fulfil all the set tasks. Therefore, this paper proposes application of scientific methods for analysing of models for possible restructuring of Road traffic inspection in the Republic of Croatia, advantages and disadvantages of the proposed models and the possibility of further improvement of this service

Procijena malnutricije te nutritivna terapija i potpora u pacijenata s kolorektalnim karcinomom

Introduction: Malnutrition is a common problem in oncological patients. Prevalence of malnutrition in patients with colorectal carcinoma ranges between 30%-50% at presentation. Nutritional status in patients with malignant tumours affects the quality of life and overall survival. Involuntary weight loss is common in these patients and is associated with poor postoperative outcome and longer hospital stay. Malnutrition is also associated with reduced tolerance and response to systemic antineoplastic therapy. Methods and Results: We describe the results of our studies which evaluated the effects of nutritional screening in indentifying patients at risk for malnutrition,for prompt nutritive support and careful follow up. The results show that proactive intervention and correction of malnutrition in an early stage reduces patient costs, length of hospital stay, improves response to treatment and improves functional status and quality of life. Conclusion: Early routine nutrition screening, assessment and interventionsare effective in improving nutritional status and reduced complications, toxicities and improve clinical outcomes in colorectal carcinoma patients.Uvod: Pothranjenost je jedan od vodećih problema u oboljelih od karcinoma probavnih organa, pa tako u oboljelih od kolorektalnog karcinoma pojavnost joj je izme|u 30% - 50% u novodijagnosticiranih pacijenata. Nutritivni status u karcinomskih bolesnika direktno utječe na kvalitetu života i preživljenje. Neželjeni gubitak tjelesne mase povezan je sa lošijim ishodom kirurškog liječenja i duljim poslijeoperacijskim i bolničkim liječenjem, kao i sa slabijim podnošenjem i učinkom antineoplastičke terapije. Metode i rezultati: Evaluirali smo rezultate studija koje prate učinke ranog otkrivanja malnutricije u oboljelih od karcinoma kao i pravovremene i primjerene nutritivne potpore uz kontinuirano praćenje nutritivnog statusa u oboljelih. Rezultati pokazuju da prepoznavanjem i ranom nutritivnom intervencijom popravljamo kvalitetu života, preživljenje i smanjujemo komplikacije antitumorskog liječenja u karcinomskih bolesnika uz snižavanje troškova i skraćujemo trajanje bolničkog liječenja. Zaključak: Rana evaluacija nutritivnog statusa i nutritivna potpora u oboljelih od karcinoma doprinosi manjoj učestalosti komplikacija i boljem ishodu liječenja u oboljelih od kolorektalnog karcinoma manjem

Predskazatelji intenziteta akutne poslijeoperacijske boli u bolesnica s karcinomom dojke

To date, modern medicine does not have reliable tools for objectifying and measuring pain. In order to avoid the development of chronic pain, we must effectively treat intraoperative and postoperative acute pain. In this prospective study, we wanted to estimate whether and to what extent algometer and PSQ (Pain Sensitivity Questionnaire) and CSQ (Coping Strategies Questionnaire) predict the intensity and strength of postoperative pain. Accordingly, we wanted to adjust the analgesia protocol. The study was conducted from February to April 2019, at the University Hospital for Tumors in Zagreb, and included 100 patients who were admitted to the hospital for breast cancer surgery. Preoperatively all patients completed PSQ and CSQ questionnaires and pain sensitivity was measured with the algometer. The same analgesic protocol was applied to all patients. The pain was measured postoperatively by NRS (numeric rating scale) 2, 6, 12, 18, 24, 48 and 72 hours after the operation. According to the obtained results, the patients were grouped into the group of slightly sensitive, medium sensitive, or very sensitive. Correlation between PSQ and NRS was statistically significant in the group of very sensitive patients. Research has shown that algometer can identify very sensitive patients and enables planning the analgesic protocol prior the operation. We can conclude that the analgesic protocol applied during the study was successful in preventing postoperative pain.Sve do sada moderna medicina nema pouzdane alate za objektiviziranje i mjerenje boli. Učinkovitim liječenjem boli intraoperativno i postoperativno spriječavamo pojavu kronične boli. U ovom istraživanju željeli smo utvrditi možemo li i u kojoj mjeri pomoću algometra te PSQ i CSQ upitnika procijeniti intenzitet i snagu postoperativne boli te prema tome prilagoditi protokol analgezije. Istraživanje smo provodili od veljače do travnja 2019, u Klinici za tumore u Zagrebu, a obuhvatilo je 100 bolesnica koje su primljene u bolnicu radi operacije raka dojke. Preoperativno su sve bolesnice ispunile PSQ i CSQ upitnike, a algometrom smo izmjerili bolnu osjetljivost. Kod svih bolesnica primjenili smo isti analgetski protokol. Postoperacijska bol mjerena je NRS ljestvicom 2, 6, 12, 18, 24, 48 i 72 sata nakon operacije. Prema vrijednostima dobivenim algometrom, bolesnice su podijeljene u tri skupine; malo osjetljive, srednje osjetljive i vrlo osjetljive na bol. Korelacija između PSQ upitnika i NRS-a je statistički značajna u skupini vrlo osjetljivih bolesnica. Istraživanje je pokazalo da algometar može identificirati vrlo osjetljive bolesnice te omogučiti preoperativno prilagođavanje analgetskog protokola

Dynamics of change in coagulation parameters in carcinoma patients with epidural analgesia following liver resection

Background and Purpose: Liver resection is associated with postoperative coagulopathy. There is a risk of occurrence fatal epidural anaesthesia (EA) complications. The purpose of this study is to monitor the dynamics of change in coagulation parameters with regard to the resected mass of the liver tissue in patients with continuous thoracic epidural analgesia. Materials and Methods: The retrospective study included 57 patients, with liver resection performed due to metastases of colon carcinoma with normal preoperative coagulation status, that underwent the technique of continuous thoracic epidural analgesia (TEA) and general anaesthesia. The patients were divided into two groups depending on the number of resected liver segments. The Small Resections’ group (SR) included patients that had one or two liver segments removed while the Major Resection (MR) group included patients that had three of more liver segments removed. Resected liver tissue mass, prothrombin time (PT) values and platelet count were analyzed during five postoperative days (PODs). Results and Conclusions: There is a statistically significant difference of PT value (p<0.001) during five days within each of the tested groups, as well as between both groups (p<0.001). During all five PODs there is a negative correlation between PT values and removed liver tissue mass in both patient groups. The analysis showed that by removing liver mass larger than 165 gwe can expect PT<0.7. TEA application after liver resection is a technique that demands individual assessment of the expected patient postoperative coagulation status. Resected liver tissue mass can be an effective predictor of postoperative coagulopathy