Analiza sidrenja poluuronjive platforme Scarabeo 7

U ovom su radu prikazani rezultati analize sidrenja poluuronjive platforme Scarabeo 7 prema pravilima dvaju klasifi kacijskih društava, American Petroleum Institute (API) i Det Norske Veritas (DNV). Pravila tih dvaju klasifi kacijskih društava najčešće se koriste za analizu sidrenja, pa je cilj rada bila usporedba rezultata analize sidrenja prema API i DNV kriterijima. Prigodom sidrenja objekta morske tehnike moraju se zadovoljiti dva osnovna kriterija: maksimalni pomak objekta koji je ograničen kako bi se izbjeglo oštećenje ili pucanje podmorskoga podizača i maksimalna napetost u sidrenoj liniji koja je određena faktorom sigurnosti i silom pri kojoj će doći do pucanja linije, a koju defi nira proizvođač. Analiza sidrenja za operativno stanje pokazala je da zadani sidreni sustav u potpunosti zadovoljava kriterije pri ekstremnim vremenskim uvjetima (vjetar, valovi i morske struje) za jednogodišnje povratno razdoblje. Za slučaj neoperativnoga stanja, kad je podmorski podizač još uvijek pričvršćen za ušće bušotine, analizom je ustanovljeno da sidreni sustav zadovoljava kriterije za vremenske uvjete desetogodišnjega povratnog razdoblja umanjene za maksimalno 20 posto u analizi prema API pravilima i maksimalno 25 posto u analizi prema DNV pravilima. Tako dobiveni rezultati koji su dobiveni analizom zadovoljili su sve uvjete, tj. maksimalne dopuštene pomake i čimbenike sigurnosti

Dermatomyositis as paraneoplastic syndrome of peritoneal and ovarian relapse after long-term complete remission in patient with metastatic bilateral breast cancer [Dermatomiozitis kao paraneoplastički sindrom peritonealnog i ovarijalnog relapsa nakon dugog perioda potpune remisije u bolesnice s metastatskim bilateralnim rakom dojke]

Dermatomyositis is a rare disease characterised by inflammatory muscle affection and characteristic cutaneous changes. When occuring in a patient with cancer, dermatomyositis may indicate recurrence or progression and poor outcome. Herein, the treatment of metastatic breast cancer, metastatic pattern, characteristics of long-term survivors, and link between dermatomyositis and breast cancer are discussed and the literature reviewed. We report a 57-year old female patient with metastatic bilateral breast cancer whose ovarian and peritoneal relapse after long-term remission was disclosed by occurence of paraneoplastic dermatomyositis. The patient previously had a 15-year long disease free-period after primary treatment for breast cancer before onset of pulmonary dissemination. Following antracycline-based chemotherapy, the complete remission lasting another 15 years was accomplished. Dermatomyositis had been resolved upon induction of second-line taxane-based chemotherapy. After completion of six cycles of gemcitabine and paclitaxel chemotherapy, check-up revealed further progression. The patient subsequently underwent six cycles of third-line CAP chemotherapy (cyclofosfamide, doxorubicine, cisplatin) but disease progressed and oral capecitabine chemotherapy was initiated. The patient received four cycles of capecitabine followed by further vast progression and finally expired following massive pulmonary embolism. Our case stresses the need of thorough staging and check-up when dermatomyositis arises in patients with breast cancer, regardless of previous stable long-term complete remission. Furthermore, we believe that treatment with curative intent in young patients with metastatic breast cancer, who have good performance statuses and no comorbidities is required, because it is more likely to produce long-term complete remission. However, following disease relapse a poor outcome can be expected

PERINATAL AND NEUROMOTOR OUTCOME OF NEWBORN AFTER IVF et ET

SAŽETAK Analiziran je perinatalni ishod 433 poroda i 636 novorođenčadi nakon izvantjelesne oplodnje i transfera embrija (IVF-ET) u Klinici za ženske bolesti i porode KBC-a u Zagrebu u razdoblju od 2000. do 2003. godine. Rezultati su uspoređeni s podatcima o 20 468 ostale djece rođene u istom razdoblju. Od IVF-ET trudnoća bilo je 40,19% višeplodnih, od toga 29,06% s dvojcima, 8,96% s trojcima i 2,42% s četvorcima. Od ostalih trudnoća bilo je 310 (1,52%) višeplodnih, gotovo samo dvojci, te 3 trudnoće (0,01%) s trojcima. Uspoređujući trudnoće i novorođenčad nakon IVF-ET s onim ostalim, nađeno je: mrtvorođenih 4,41% : 1,26%, SC 72,64% : 11,41%; porod < 37 tjedana 49,85% : 11,37%; djeca niske težine 40,88% : 5,8%; vrlo niske težine 12,42% : 1,42%; ekstremno niske težine 4,25% : 1,03%. U jednoplodne novorođenčadi nakon IVF-ET nisu nađene razlike u odnosu na ostale jednoplodne trudnoće, ali su nađene izrazite razlike perinatalnog ishoda u blizanačkim trudnoćama. Bilo je 356 blizanačkih trudnoća nakon IVF-ET i 280 spontano začetih blizanačkih trudnoća. Među njima su nađene razlike perinatalnog ishoda: FM je nakon IVF-ET bio 66,7‰, prema 14,5‰ u ostalim višeplodnim trudnoćama; RNM 25,0‰ : 39,0‰; PNM 92,0‰ : 53,0‰. U 111 trojaka FM nakon IVF-ET bio je 72,0‰, RNM 36,0‰ i PNM 108,0‰; u ostalih 9 trojaka iz tri trudnoće nije bilo mortaliteta. Svi su trojci, i oni iz IVF-ET postupka i oni “ostali”, rođeni SC-om. Bile su 4 četveroplodne trudnoće, sa 16 plodova, sve iz IVF-ET programa, sva su djeca rođena prije 37 tjedana, SC-om, FM je bio 125,0‰, RNM 187,0‰ i PNM 312,0‰. Velikih malformacija je u djece rođene nakon IVF-ET bilo 3,77%, u “ostalih” 1,67%. Autori su potvrdili veću ugroženost djece nakon IVF-ET postupka, što je uzrokovano većom učestalošću višeplodnih trudnoća, novorođenčadi < 37 tjedana, djece < 2500 grama. Trudnoće nakon IVF-ET su visokorizične i zahtijevaju poseban nadzor i pozornost.The pernatal outcome of 433 deliveries and 643 newborns, conceived following IVF-ET procedure at a Dep. of Obst. And Gyn. Of Clinical Medical Centre Zagreb in the period 2000-2003 is analyzed. The results are compared to the outcome of 20468 other infants born infants in the same period. The 40,19% of IVF-Et pregnancies were multifetal, among them 29,06 with twins, 8,96 with triplets and 2,42% with quadruplets. Among other 20468 deliveries 310 (1,52%) were multifetal, almost exclusvely twins and only 3 pregnancies with triplets. When correlating the IVF-ET pregnacies and newborns to all others it was established: stillbirth 4,41% versus 1,26%; SC 72,46 vs 11,41% ; delivery < 37 weeks 49,85% vs 11,37; infants LBW 40,88% vs 1,42% ; ELBW infants 4,25% vs 1,03%. In singletons following IVF-ET no difference in relation to spontaneus concevid, whereas well-defined differences in mutiple pregnacies between IVF-ET and spontaneus concevide twins were found: FM in IVF-ET was 66,7 ‰ vs 14,5 ‰, ENM 25,0‰ vs 30,0‰; PM 92,0‰ vs 53,0 ‰. In 111 triplets following IVF-ET fetal mortality Stručni rad Medicina 2007;43:270-278 Professional paper UDK: 618.177-089.888.111:618.2/4 270 was 72,0‰, ENM 36,0 ‰, and PM 108,0‰. Gross malformations in the total IVF-ET group were 3,77% vs 1,67% in othere pregnacies. The authors have confirmed the higher risk of IVF-ET pregnacies, that is caused by higher rate of mutiple pregnacies, of newborns < 37 w., infants < 2500 g. The pregnacies following IVF-ET are high risk pregnancies, they claim for special attention and perinatal care

Koncentracija uree u kozjem mlijeku: važnost određivanja i čimbenici varijabilnost

The optimal concentration of urea in cow\u27s milk is known and is often used to assess the balance of energy and protein in diets. While in goat (and sheep) milk it is not controled nor defined. Main determinants of urea formation in milk are the amount of crude protein intake and the ratio betwwen protein and energy proportion in diet. Goat diet with excessive amount of crude protein and energy unbalanced diet cause the excess of nitrogenous substances in rumen along with release of ammonia and rise in concentration of urea in blood and milk, which adversely affects the production, milk coagulation propreties, environmental pollution and reproductive capabilities of goats. However, besides diet, there are other factors that influence milk urea concentration: breed, stage of lactation, parity, season, body mass, litter size, production and chemical composition of milk. Numerous studies conducted on cow milk included the influence of sources of variability listed above, while there are only few studies available for goat milk due to its less economic importance, seasonal polyesterity and different way of breeding and keeping goats. The aim of this paper is to comparatively and critically combine the previous research results on the importance of determining the milk urea concentration as well as on individual sources of variability of urea concentration in goat milk.Optimalna koncentracija ureje u kravljem mlijeku je poznata i često se koristi za procjenu izbalansiranosti obroka energijom i proteinima, dok u kozjem (i ovčjem) mlijeku još uvijek nije definirana. Glavne odrednice stvaranja ureje u mlijeku jesu količina sirovih proteina u obroku i omjer proteinskog i energetskog dijela obroka. Hranidba koza s prekomjernom količinom sirovih proteina i energetski neuravnotežena hranidba uzrokuje višak dušičnih tvari u buragu, uz oslobađanje amonijaka i porast koncentracije ureje u krvi i mlijeku, što može nepovoljno utjecati na proizvodnju, koagulacijske osobine mlijeka, zagađenje okoliša i reproduktivne odlike koza. Međutim, osim hranidbe, postoje i drugi čimbenici koncentracije ureje u mlijeku: pasmina, stadij i redoslijed laktacije, vrijeme mužnje, sezona, tjelesna masa, veličina legla, proizvodnja i kemijski sastav mlijeka. Brojne studije provedene na kravljem mlijeku uključivale su utjecaj navedenih izvora varijabilnosti, dok je za kozje mlijeko dostupno svega nekoliko studija, vjerojatno zbog njegove manje ekonomske važnosti, sezonske poliestričnosti i različitog načina uzgoja i držanja koza. Cilj ovog rada je komparativno i kritički objediniti dosadašnje rezultate istraživanja o važnosti određivanja koncentracije ureje kao i pojedinim izvorima varijabilnosti koncentracije ureje u kozjem mlijeku

Dental Status as a Quality Control Health Care Parameter for Children with Disabilities

The aim of this study was to determine the level of dental health condition in children with disabilities and to find out weather dental health status might be used as a quality control parameter regarding overall health care for disabled children. Disabled and healthy children from 3 to 17 years old were examined. There were 86 boys and 34 girls in each group. Dental health status was evaluated using the World Health Organization diagnostic criteria for decayed, missing and filled teeth. The relations between mean decayed, missing and filled teeth index for primary, mixed and permanent dentition showed no statistically significant differences among groups. Our results showed that disabled children have evenly level of dental caries as their healthy peers. One can conclude that organized health care for disabled children have positive influence on dental care, too. Furthermore, dental status as an indicator of dental care level might be used as a parameter for quality control regarding overall health care for disabled children

MAGNETSKA REZONANCA POBOLJŠAVA PRENATALNU DIJAGNOZU TUBEROZNE SKLEROZE

Tuberous sclerosis (TS) is a genetically determined, multisystem disorder. There is no consistent correlation between specific TSC gene mutation and clinical outcome. This fact diminishes the value of prenatal TS genetic testing to future infant’s clinical outcome. Authors have shown how imaging techniques could increase accuracy of prenatal diagnosis. They have described a case of prenatally diagnosed TS by using high frequency real time ultrasound and fetal cranial magnetic resonance imaging (MRI) in the second half of an uneventful pregnancy. A 25-year old patient has been studied from 27 weeks of gestation and repeating echocardiographic examinations of the female fetus revealed two solid cardiac tumors. One of them arose from the interventricular septum, while the other from the right atrium. Fetal cranial MRI has been performed at 36 weeks of gestation. Identified signal abnormalities, which correspond to brain hamarto¬mas, highly suggested presence of TS in fetus. An infant was born at term by vaginal delivery. At the age of four months West’s syndrome has been diagnosed. In addition, authors discuss an ethical problem that may arise when the fetal tests reveal presence of TS.Tuberozna skleroza (TS) je genetski poremećaj koji se nasljeđuje autosomno dominantno, a hipotetski geni koji svojom mutacijom mogu uzrokovati TS su na kromosomu 9 (TSC 1) i 16 (TSC 2). Pretpostavlja se prevalencija od jednog slučaja TS na 6000 živorođenih, podjednako zahvaća oba spola i sve rase i etničke skupine. Najčešće se dijagnosticira u ranom djetinjstvu zbog neuroloških simptoma – epileptičkih napadaja i različito izraženog mentalnog hendikepa. Bolest je karakterizirana rastom dobroćudnih tumora (angiofibroma) u brojnim organima, primarno u mozgu, očima, srcu, koži i plućima, što otvara realne mogućnosti da se spomenuti poremećaj otkrije i prije rođenja. U radu je opisana 25-godišnja trudnica, prvorotkinja, u čijeg su djeteta pomoću ultrazvuka odnosno magnetske rezonance prenatalno otkriveni tumori srca i mozga. Prigodom ultrazvučnog pregleda u 27. tjednu trudnoće, na poprečnom presjeku kroz fetalni grudni koš, opažene su dvije solidne, homogene i hiperehogene strukture. Jedna, u području interventrikularnog septuma, izgledala je kao njegovo vretenasto odnosno trokutasto zadebljanje od 10 mm u najdebljem dijelu, dok je druga, u ¬području lateralne stijenke desnog atrija uz inserciju trikuspidalnog zaliska, bila sličnih mjera, ali više okruglasta. Obje opisane tumorske tvorbe bile su avaskularne. Rad srca bio je ritmičan i nije bilo poremećaja hemodinamike. Preostala ¬fetalna morfologija bila je uredna. U pupkovini su se nalazile samo dvije krvne žile, pri čemu je promjer jedine umbilikalne arterije iznosio 4 mm. Kontrolnim pregledima ustanovljava se uredan fetalni rast, povećanje spomenutih rabdomioma srca uz očuvanu kontraktilnost i ritmični rad. U 36. tjednu trudnoće učinjen je pomoću magnetske rezonance fetalni ¬kraniogram. Otkriveni hiperintenzivni signal subependimalno, u blizini nukleus kaudatusa odnosno foramena Monroi s desne strane, odgovarao je ekspanzivnoj formaciji (hamartomu) čije je prisustvo sugeriralo postojanje TS u fetusa. Točno u terminu porođeno je vitalno žensko novorođenče urednog fizikalnog odnosno auskultatornog nalaza srca i pluća. U dobi od četiri mjeseca života majka po prvi put primjećuje u svog djeteta iznenadne trzajeve tijela, ruku i nogu, uz plač i vrisak. U neurološkom statusu prevladava generalizirana mišićna hipotonija, dok su refleksi uredni. EEG-ski se otkrivaju žarišna izbijanja lijevo temporoparijetalno s generalizacijom po tipu hipsaritmije. Postavljena je dijagnoza tuberozne skleroze i West-ova sindroma. CT mozga pokazuje progresiju cerebralnih promjena, a ultrazvučni nalazi blažu regresiju ¬rabdo¬mioma srca. Opisani slučaj dokazuje da se uz kombiniranu uporabu navedenih slikovnih dijagnostičkih metoda može računati s prenatalnom dijagnozom i onih relativno rijetkih genetskih poremećaja koji se klinički manifestiraju i uobičajeno dijagnosticiraju tek u dječjoj dobi. Autori raspravljaju o etičkom problemu priopćavanja medicinskih informacija ¬nakon što se postavi prenatalna dijagnoza TS

NEWBORNS OF MOTHERS WITH EPILEPSY

Cilj rada. Na temelju izabranih parametara usporediti novorođenčad majki s epilepsijom i novorođenčad rođenu od zdravih majki te utvrditi utječe li i u kojoj mjeri epilepsija na rani neonatalni ishod. Metode. Retrospektivnim istraživanjem u razdoblju od deset godina izdvojeno je 869 novorođenčadi. Ispitivanu skupinu sačinjavalo je 175 novorođenčadi majki oboljelih od epilepsije, a kontrolnu skupinu 694 novorođenčadi zdravih majki. Analizirani su gestacijska dob kod poroda, način dovršenja poroda, porodna težina, porodna duljina, opseg glave, Apgar ocjena u 1. i 5. minuti, ­postojanje prirođenih anomalija, postupci primijenjeni u okviru postnatalnog prihvata i skrbi novorođenčeta te eventualne bolesti u novorođenčeta. Rezultati. Novorođenčad kojih su majke bolovale od epilepsije nije se statistički značajno razlikovala od novorođenčadi rođenih od zdravih majki ni u jednom promatranom parametru. Zaključak. Rezultati našeg istraživanja pokazuju da uz odgovarajuću antenatalnu skrb, prihvat i opskrbu novorođenčeta, žene oboljele od epilepsije mogu roditi zdravo dijeteObjective. To compare specific parameters in children born to mothers with epilepsy and children born to healthy mothers. The aim is to determine possible differences among groups and to establish whether and in which degree mother\u27s disorder affects the neonates. Methods. Retrospective study of children born to mothers with epilepsy and ­children born to healthy mothers at the University Hospital of Rijeka, Department of Obstetrics and Gynecology, over ­period of ten years. Statistical evaluation of the hospital records data. Compared parameters were gestational age, mode of delivery (vaginal delivery/ caesarean section), birth weight, birth length, head circumference, Apgar scores in first and fifth minute, the presence of congenital anomalies, performed postnatal procedures (divided in two groups: more and less invasive procedures) and the neonatal health condition. Neonatal disorders were grouped in five diagnostic categories: breathing disorders, birth damages (with the exception of brain damages), brain damages and convulsions, icterus, infections and skin diseases. A total of 869 neonates have been studied. Among them, 175 children were born to mothers with epilepsy. The control group consisted of 694 children born to healthy mothers. Multiple pregnancies and still-born ­children were not taken into the consideration. Results. A total of 869 neonates have been evaluated and their corresponded parameters compared. The mean gestational ages, birth lengths, birth weight, head circumferences, mode of ­delivery and Apgar scores, as well as the evaluation of performed postnatal procedures and existence of the disorders ­presented no statistically significant differences among groups. The appearances of congenital disorders within specific groups measured in percentages show that the incidence is about twice as high in the group of children born to mothers with epilepsy, compared to the group of children born to healthy mothers (6,28% and 3,03%, respectively). There is, ­however, no statistically significant difference between the groups (2= 3,82; p=0,05). Conclusion. There are no statistically significant differences between children born to mothers with epilepsy compared to those born to healthy mothers. Evaluation of the mean birth weights among groups shows that the values are within the referent borders. Obtained results oppose to current findings that suggest low birth weight is seen about twice as often in infants of mothers with epilepsy. Our results confirm the fact that the risk for congenital malformations in children born to mothers with epilepsy is about twice that for the general population. Lack of statistically significant difference in the rate of congenital anomalies ­between the group of children born to mothers with epilepsy and those born to healthy mothers could be explained by the retrospective design of the study and the fact that the information were taken from the hospital records (instead of being collected specifically for the purpose of the study). Such results urge for prospective follow up of women with epilepsy and their offspring and for development of registries of pregnant women with epilepsy and their children which would ­ensure recognition and register of congenital malformations. Obtained results show that, with adequate antenatal and postnatal medical care of mothers and neonates, women with epilepsy can fulfill their reproductive function and give birth to a healthy child

Dozimetrijska verifikacija radioterapijskih planova intezitet-modulirajuće radioterapije u bolesnika s rakom prostate

Intensity modulated radiotherapy (IMRT) has become widely used as a standard radiation therapy technique for the treatment of localized prostate cancer. The transition from conformal radiotherapy (3D CRT) to a more complex IMRT technique triggered the need for more thorough verification of the accuracy in the dose delivery. In this work we present the clinical workflow and the results of patient specific quality assurance (PSQA) procedures for 40 prostate cancer patients who have been treated with step and shot IMRT ever since its implementation in our routine clinical practice. PSQA procedures include dosimetric verification of each treatment plan with dedicated rotational phantom and high-resolution matrix detector system Octavius 4D (PTW Freiburg) that allows three-dimensional comparison of the calculated and delivered radiation dose distribution. Our results proved the compliance with the universal tolerance limits recommended for those procedures (1), assuring the safety of the treatment and providing the possibility for the adoption of more stringent constraints in the future.Radioterapija moduliranog intenziteta (eng. intensity modulated radiotherapy –IMRT) u posljednjem desetljeću je postala uobičajena radioterapijska metoda za terapiju lokaliziranih karcinoma prostate. Prelazak s konformalne radioterapije na napredniju i tehnički složeniju IMRT tehniku, donio je i potrebu za detaljnijom i sveobuhvatnom provjerom točnosti isporuke doze zračenja. U ovom radu predstavljamo provođenje postupaka dozimetrijske verifikacije radioterapijskih planova poznatih pod engleskim nazivom patient specific QA (PSQA) te rezultate za 40 bolesnika s karcinomom prostate koji su primili IMRT terapiju. U tu svrhu koristimo posebni dozimetrijski sustav s rotacijskim fantomom i visoko razlučivom detektorskom matricom, Octavius 4D (PTW Freiburg). Pokazalo se kako su sva dobivena odstupanja između planirane i mjerene trodimenzionalne raspodjele doze bila unutar preporučenih tolerancija (1) što nam daje povjerenje u sigurnost provođenja ovakve terapije te otvara mogućnost za primjenu strožijih ograničenja u budućnosti