Chronic lung disease in premature infants

Kronična plućna bolest je bolest pluća koja nastaje akutnim zbivanjem u novorođenačkom razdoblju. Većina nastaje iz bronhopulmonalne displazije, koja se uobičajeno opisuje kao posljedica liječenja respiratornog distres sindroma u nedonoščadi kisikom i mehaničkom ventilacijom. Definira se kao ovisnost o dodatnom kisku u trajanju duljem od 28 dana. Bronhopulmonalna displazija se prvenstveno objašnjava kao razvojni poremećaj izuzetno nedonošene djece u kojemu prijevremeni porod i preuranjeni početak izmjene plinova interferiraju s normalnim razvojem alveola i plućnih krvnih žila. Tijekom ovog ranog razvojnog stadija, čak i minimalna izloženost štetnim čimbenicima, kao što su mehanička ventilacija, toksično djelovanje kisika ili infekcija, može poremetiti ovaj proces. Prevencija kronične plućne bolesti prvenstveno je usmjerena na prevenciju prijevremenog poroda. Od ostalih strategija koriste se manje invazivni oblici mehaničke ventilacije, primjena surfaktanta, sprječavanje prekomjerne izloženosti kisiku, terapija kofeinom i dr. Glavni cilj liječenja je svođenje daljnje ozljede pluća na što manju razinu, usporedno stvarajući optimalne uvjete za rast i oporavak. U većine pacijenata s cijeljenjem i rastom pluća dolazi do postupnog poboljšanja. Cilj ovog rada bio je prikazati obilježja djece rođene u Klinici za ženske bolesti i porode KBC-a Zagreb tijekom 2017. koja su zahtijevala nadomjesnu terapiju kisikom najmanje 28 dana nakon poroda. U navedenom periodu rođeno je ukupno 41 takvo dijete, što odgovara incidenciji od 1%. Većina novorođenčadi rođena je prije navršenog 28. tjedna gestacije i rodne mase manje od 1000 g. Incidencija i težina kliničke slike bronhopulmonalne displazije bile su obrnuto proporcionalne gestacijskoj dobi i rodnoj masi. Ostali promatrani rizični čimbenici uključivali su intrauterini zastoj u rastu, Apgar ocjenu, izloženost kisiku i vrste respiratorne potpore. Ovo istraživanje deskriptivne je naravi, a provedeno je na relativno malom uzorku, te zbog toga nije pouzdano u donošenju općenitih zaključaka.Chronic lung disease is a respiratory disease that usually evolves from an acute respiratory disorder experienced by a newborn infant. The majority of cases arise from bronchopulmonary dysplasia, which is usually described as a disease subsequent to oxygen and/or ventilator therapy for respiratory distress syndrome in preterm newborns. It is defined by oxygen requirement for at least 28 days. Bronchopulmonary dysplasia is primarily interpreted as a developmental disorder in extremely premature infants in which premature birth and the initiation of pulmonary gas exchange at this early stage appear to interrupt the normal alveolar and vascular growth. At this early developmental stage, even minimal exposure to injurious factors, such as mechanical ventilation, oxygen toxicity, or infection, may interrupt this process. Prevention of chronic lung disease is primarily focused on preventing preterm birth. Other strategies include the use of less invasive mechanical ventilation strategies, surfactant administration, prevention of excess oxygen exposure, caffeine therapy, etc. Management is directed at minimizing further injury and providing an optimal environment to support growth and recovery. Most patients gradually improve as healing occurs and lung growth continues. The aim of this thesis was to present the characteristics of infants born at the Department of Gynecology and Obstetrics, University Hospital Center Zagreb, in the year 2017, who required supplemental oxygen for at least 28 postnatal days. During this period, 41 such infants were born, which corresponds to an incidence of 1%. The majority of newborns were born before 28 weeks of gestation and weighing less than 1000 g. The incidence of bronchopulmonary dysplasia, as well as the severity of the disease, increased with decreasing gestational age and birth weight. Additional risk factors that were observed include intrauterine growth restriction, Apgar score, exposure to oxygen and respiratory support modalities. This descriptive research was carried out on a relatively small sample and therefore it is not reliable in making general conclusions

Chronic lung disease in premature infants

Kronična plućna bolest je bolest pluća koja nastaje akutnim zbivanjem u novorođenačkom razdoblju. Većina nastaje iz bronhopulmonalne displazije, koja se uobičajeno opisuje kao posljedica liječenja respiratornog distres sindroma u nedonoščadi kisikom i mehaničkom ventilacijom. Definira se kao ovisnost o dodatnom kisku u trajanju duljem od 28 dana. Bronhopulmonalna displazija se prvenstveno objašnjava kao razvojni poremećaj izuzetno nedonošene djece u kojemu prijevremeni porod i preuranjeni početak izmjene plinova interferiraju s normalnim razvojem alveola i plućnih krvnih žila. Tijekom ovog ranog razvojnog stadija, čak i minimalna izloženost štetnim čimbenicima, kao što su mehanička ventilacija, toksično djelovanje kisika ili infekcija, može poremetiti ovaj proces. Prevencija kronične plućne bolesti prvenstveno je usmjerena na prevenciju prijevremenog poroda. Od ostalih strategija koriste se manje invazivni oblici mehaničke ventilacije, primjena surfaktanta, sprječavanje prekomjerne izloženosti kisiku, terapija kofeinom i dr. Glavni cilj liječenja je svođenje daljnje ozljede pluća na što manju razinu, usporedno stvarajući optimalne uvjete za rast i oporavak. U većine pacijenata s cijeljenjem i rastom pluća dolazi do postupnog poboljšanja. Cilj ovog rada bio je prikazati obilježja djece rođene u Klinici za ženske bolesti i porode KBC-a Zagreb tijekom 2017. koja su zahtijevala nadomjesnu terapiju kisikom najmanje 28 dana nakon poroda. U navedenom periodu rođeno je ukupno 41 takvo dijete, što odgovara incidenciji od 1%. Većina novorođenčadi rođena je prije navršenog 28. tjedna gestacije i rodne mase manje od 1000 g. Incidencija i težina kliničke slike bronhopulmonalne displazije bile su obrnuto proporcionalne gestacijskoj dobi i rodnoj masi. Ostali promatrani rizični čimbenici uključivali su intrauterini zastoj u rastu, Apgar ocjenu, izloženost kisiku i vrste respiratorne potpore. Ovo istraživanje deskriptivne je naravi, a provedeno je na relativno malom uzorku, te zbog toga nije pouzdano u donošenju općenitih zaključaka.Chronic lung disease is a respiratory disease that usually evolves from an acute respiratory disorder experienced by a newborn infant. The majority of cases arise from bronchopulmonary dysplasia, which is usually described as a disease subsequent to oxygen and/or ventilator therapy for respiratory distress syndrome in preterm newborns. It is defined by oxygen requirement for at least 28 days. Bronchopulmonary dysplasia is primarily interpreted as a developmental disorder in extremely premature infants in which premature birth and the initiation of pulmonary gas exchange at this early stage appear to interrupt the normal alveolar and vascular growth. At this early developmental stage, even minimal exposure to injurious factors, such as mechanical ventilation, oxygen toxicity, or infection, may interrupt this process. Prevention of chronic lung disease is primarily focused on preventing preterm birth. Other strategies include the use of less invasive mechanical ventilation strategies, surfactant administration, prevention of excess oxygen exposure, caffeine therapy, etc. Management is directed at minimizing further injury and providing an optimal environment to support growth and recovery. Most patients gradually improve as healing occurs and lung growth continues. The aim of this thesis was to present the characteristics of infants born at the Department of Gynecology and Obstetrics, University Hospital Center Zagreb, in the year 2017, who required supplemental oxygen for at least 28 postnatal days. During this period, 41 such infants were born, which corresponds to an incidence of 1%. The majority of newborns were born before 28 weeks of gestation and weighing less than 1000 g. The incidence of bronchopulmonary dysplasia, as well as the severity of the disease, increased with decreasing gestational age and birth weight. Additional risk factors that were observed include intrauterine growth restriction, Apgar score, exposure to oxygen and respiratory support modalities. This descriptive research was carried out on a relatively small sample and therefore it is not reliable in making general conclusions

Regulacija diferencijacije stanica akutne promijelocitne leukemije koštanim morfogenetskim proteinima [Effect of bone morphogenetic proteins on differentiation of human promyelocytic leukemia cells]

Acute promyelocytic leukemia (APL) is malignant hematologic disease characterized by translocation t(15;17). This translocation results in the formation of PML/RARα oncogene and accumulation of malignant promyelocytes that do not differentiate into mature granulocytes. Treatment of this type of leukemia is based on differentiation agents all-trans retinoic acid (ATRA) and arsenic-trioxide, which induce degradation and conformational changes of the oncogene PML/RARα. However, prolonged treatment with ATRA often results in relapse, due to development of ATRA resistance by leukemic cells, and serious side-effects. In this research we aimed to investigate possible mechanisms of BMP-mediated suppression of ATRA-induced differentiation using myeloid leukemia cell lines NB4 and HL60. We used two myeloid leukemia cell lines: NB4, which carries the specific t(15;17) translocation, and HL60, a myeloblastic leukemia cell line that lacks t(15;17) translocation, to test if the BMP effect is PML/RARα specific. Cell lines were treated with ATRA and BMPs, and, in some experiments, BMP-antagonists NOGGIN. ATRA induced differentiation of malignant promyelocytes into neutrophils in both tested cell lines. Addition of BMPs in ATRA-treated samples significantly reduced the percentage of differentiated cells. This anti-differentiation effect of BMPs was reversed by BMP-antagonist NOGGIN. To investigate the mechanism of anti-differentiation effect of BMPs on ATRA-treated myeloid leukemia cell lines NB4 and HL60, we analyzed the expression pattern of several genes involved in proliferation, differentiation and apoptosis, which are, at the same time, involved in both BMP- and ATRA-signaling pathway. Those in vitro results were confirmed in bone marrow and peripheral blood samples of APL patients. Gene expression analysis revealed induction of ID expression in both NB4 cell line and bone marrow APL samples. Addition of BMPs further enhanced ID gene expression in NB4 cells. Moreover, ATRA induced expression of differentiation genes PU.1 and C/EBPε. This effect was suppressed by combined treatment with ATRA and BMP. Also, we confirmed significant positive correlation between expression of total receptor RARα, important for differentiation effect of retinoic acid, and transcription factor PU.1 in bone marrow samples of APL patients. In the same samples, cKit expression negatively correlated with PML/RARα oncogene, but positively with total RARα, indicationg the role of cKit in differentiation of APL cells. Finally, the expression of total RARα was in negative correlation with BMP-6 and in positive correlation with BMP-antagonist BAMBI. Based on the obtained results, we concluded that ID genes and proteins could mediate antidifferentation effect of BMPs. Also, our findings suggest that PU.1 and C/EBPε could be responsible for the interference of BMP-signal and ATRA-differentiation effect. Results of our investigation confirmed the important role of BMPs in the pathogenesis of APL, and indicate that BMP molecules may be involved in the development of ATRA-resistance in APL patients

Aging Quantification on Alveolar Bone Loss

Objectives were to measure labial alveolar resorption using Lamendin’s method; to correlate the measured values of resorption with age at death; to determine whether age influences alveolar resorption, and if so, to quantify this impact. The study was performed during the 1992–1995 period in identified war casualties in Bosnia and Herzegovina. Data on the date, month and year of birth, and on the month and year of death were known in all cases. Measurements were carried out in 845 anterior monoradicular maxillary and mandibular teeth from male bodies (n=198) aged 23–69, divided into five age groups of 23–29, 30–39, 40–49, 50–59 and 60–69 years. Teeth with macroscopic pathologic lesions were excluded from analysis. Lamendin’s method was used to measure the alveolar bone level on the labial aspect of the extracted teeth. Results are presented in tables. Regression analysis was used to determine the alveolar resorption increase with age. Results are also presented by the factor of alveolar resorption, where the youngest age group was divided by older age groups. In the total sample of 845 teeth, alveolar bone level of up to 3.49 mm was recorded in 740 (87.76%), of 3.50–5.99 mm in 99 (11.79%), and of >6.00 mm in 6 (0.71%) teeth. In anterior monoradicular teeth, labial alveolar resorption increased with age and showed a regular age dependent pattern toward older age groups in mandibular but not in maxillary teeth. A >6-mm pocket was very rarely recorded. Study results contribute to clinical practice, demonstrating that periodontology is a preventive discipline in dental medicine

VILLAIN OR PROTECTOR OR WORKING THROUGH DREAMS IN GROUP PSYCHOANALYTIC THERAPY

U psihoterapiji je važno razumjeti značenje snova jer snovi otkrivaju nesvjesno. San ispričan u grupi može ukazivati na nesvjesnu refleksiju grupnih događaja. Terapeut se treba pitati što je ono što sanjač ili grupa ne mogu procesuirati te pokušavaju proradom donesenog sna. S obzirom na to da snovi mogu biti kontejneri individualnih i kolektivnih anksioznosti, ako ih se ne proradi, mogu voditi u acting out. Grupni analitičari smatraju da je vrlo važno doći do latentnih misli sna u grupi ako je i kad je to moguće, posebno onih koje imaju transferni predznak. U ovom radu bit će prikazani primjeri kako je grupa donošenjem snova koji imaju grupni karakter pokušavala proraditi grupni događaj koji je utjecao na evociranje strogih roditeljskih figura. Grupa je kroz snove prorađivala otpore, negativan krak transfera te u konačnici integraciju negativnog i pozitivnog kraka.Understanding the meaning of dreams is of great importance in psychotherapy, because dreams reveal the unconscious. A dream shared with a group can indicate an unconscious reflection of group events. The therapist should inquire into what the person who had the dream or the group itself cannot process, and trying to work through the shared dream. Since dreams could represent containers of individual and collective anxiety, failure to work them through may lead to acting out. Group analysts believe that, if and when this is possible, it is important to reach the latent dream thoughts, particularly those with a transference prefix. In this paper, we will present examples of how a group attempted to work through a group event that affected the evocation of strict parental figures by discussing dreams that have a group character. Through dreams, the group worked through resistance, the negative side of transference, and ultimately, the integration of the negative and positive sides of transference

GROUP AFTER EXCLUSION OF A SUICIDAL MEMBER OR WHAT IS HIDDEN IN THE RUG

Grupna analiza (ili grupna analitička psihoterapija) je tehnika grupne psihoterapije. Uspješno liječenje u grupi za članove grupe povezano je i s terapeutovim pripremnim zadatcima vezanima uz pokretanje grupe, a to se prije svega odnosi na izbor članova te priprema tih istih članova. Razvoj grupe može se sagledati kroz određene faze grupnog razvoja. Svaka sljedeća faza grupnog razvoja oblikovana je i nadograđena na uspješno savladanu prethodnu fazu. Stoga će se rani razvojni neuspjesi pokazati kroz daljnji grupni život i grupnu dinamiku. Svrha ovog članka je prikazati tijek grupnog procesa i zbivanja u grupi vezano uz isključenje suicidalnog člana. Prvi dio prikaza odnosi se na isključenje člana, a drugi koji obuhvaća kasniji period grupe uz još uvijek prisutne posljedice koje se odnose na usporenu detronizaciju voditeljice i usporenu proradu negativnog kraka transfera te razvijanja fenomena žrtvenog jarca. Detronizacija voditelja, prorada agresivnog /negativnog kraka transfera te nalaženje žrtvenog jarca su karakteristike druge faze grupnog razvoja koja je u ovom primjeru bila prolongirana.Group analysis (or group analytic psychotherapy) is a group psychotherapy technique. For group members, successful treatment in a group is also connected with the therapist’s preparatory tasks relating to group development, which primarily refers to the selection of group members and their preparation. The development of a group can be viewed through various stages of group development. Each subsequent stage of group development is shaped and built upon the successfully mastered previous stage. Early developmental failures will, therefore, become visible through further group existence and group dynamics. The purpose of this paper is to present the course of a group process and events in the group in relation to the exclusion of a suicidal member. The first part of the presentation refers to the exclusion of the member, while the second part includes a later group period when consequences referring to the slow dethronement of the conductor and the slow working of the negative part of transference are still present, in addition to the development of the scapegoat phenomenon. The dethronement of the conductor, the working of the aggressive/negative part of transference and finding of a scapegoat are characteristics of the second phase of group development, which in this case was prolonged

Extracranial propagation of glioblastoma with extension to pterygomaxillar fossa

<p>Abstract</p> <p>Background</p> <p>Glioblastoma multiforme is a highly malignant primary brain tumor that shows marked local aggressiveness, but extracranial spread is not a common occurrence. We present an unusual case of recurrent glioblastoma in 54-year old male that spread through the scull base to the ethmoid and sphenoid sinuses, to the orbita, pterygomaxillar fossa, and to the neck.</p> <p>Methods</p> <p>A 54-year old male underwent left temporal resection because of brain tumor of his left temporal lobe. Operation was followed by external beam radiation combined with temozolomide. The tumor recurred eight months after first surgery. The patient developed swelling of left temporal region, difficult swallowing and headache. MRI of head showed recurrent tumor, which invaded orbita, ethmoid and sphenoid sinuses, nasal cavity, pterygomaxillar fossa.</p> <p>Results</p> <p>The patient died ten months after initial diagnosis of glioblastoma multiforme, and two months after his second operation.</p> <p>Conclusions</p> <p>The aggressive surgical operation helped to downsize the tumor mass as much as possible, but did not prolonged significantly the life or improved the life quality of the patient. The current literature is reviewed, and the diagnostic approaches as well as therapeutic options are discussed.</p

LOCALLY INVASIVE PAPILLARY THYROID CANCER – OUR EXPERIENCE

Dobro diferencirani karcinomi štitnjače, poglavito papilarni karcinomi, tumori su s dobrom prognozom, ali katkad imaju sklonost širenju u okolna tkiva. Širenjem tih tumora osim okolne muskulature i hrskavice, najčešće je zahvaćen gornji aerodigestivni trakt. Tijekom 2 godine (2008–2009) u Klinici za bolesti uha, nosa i grla, kirurgiju glave i vrata, KBC-a Zagreb, liječeno je 233-je bolesnika s dobro diferenciranim karcinomom štitnjače. Među njima bila su 23 slučaja lokalno invazivnoga papilarnoga karcinoma štitnjače. U ovom radu prikazali smo svoje iskustvo u liječenju 23-je bolesnika s lokalno invazivnim papilarnim karcinomom štitnjače sa posebnim osvrtom na ekstratiroidno širenje, kirurški zahvat i postoperacijsko liječenje. Naše su preporuke za liječenje takvih bolesnika totalna tiroidektomija, selektivna disekcija vrata, odstranjenje makroskopski vidljivog tumora, radikalan kirurški zahvat za tumore s intraluminalnim širenjem u područje gornjeg aerodigestivnoga trakta i postoperacijska adjuvantna terapija.Differentiated thyroid carcinomas, particularly papillary carcinoma, are the tumors with good prognosis, but sometimes have a tendency to spread into the surrounding tissue. The spread of these tumors usually involves muscle, cartilage and upper aerodigestive tract. During two years (2008–2009) at the Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Center Zagreb, 233 patients with differentiated thyroid carcinoma were treated. Among them there were 23 cases of locally invasive papillary thyroid carcinoma. In this paper we present our experience in treating 23 patients with locally invasive papillary thyroid carcinoma with special reference to extrathyroid spread, surgery and postoperative treatment. Our recommendations for the treatment of such patients are total thyroidectomy and selective neck dissection, removal of macroscopically visible tumors, radical surgery for tumors with intraluminal expansion in the upper aerodigestive tract and postoperative adjuvant therapy

Neuroendocrine Tumors of Larynx – Two Case Reports and Literature Review

Neuroendocrine tumors (NET) of the larynx are rare and heterogenous group, with much confusion about nature and classification of these neoplasms in the past. Diagnosis is based primarily on light microscopy and confirmed by immunohistochemistry and electron microscopy. A classification in 4 different types; paraganglioma, typical carcinoid, atypical carcinoid and small cell neuroendocrine carcinoma (SCNC) is a current consensus. Thorough diagnostic and a proper classification of neuroendocrine neoplasms are of paramount importance – prognosis and treatment differ significantly. We present two cases: 63-year old patient with SCNC of the larynx and a 53-year old patient with atypical carcinoid of the larynx. OctreoScan is useful tools for diagnostics and follow up of the patients and it is predictive for effectiveness of octreotide therapy

CROATIAN GUIDELINES FOR IN VITRO DIAGNOSIS OF IGE MEDIATED HYPERSENSITIVITY

In vitro dijagnostika alergijskih bolesti temelji se na određivanju koncentracije ukupnih i speciičnih IgE antitijela u serumu, koncentraciji IgG antitijela, plazmatske triptaze, eozinoilnog kationskog proteina te testu aktivacije bazoilnih leukocita. Upotreba in vitro dijagnostičkih testova mora biti temeljena na korelaciji anamneze, kliničke slike te in vivo provokativnih testova. Kliničko značenje povišene serumske koncentracije ukupnih IgE antitijela u dijagnostici alergijskih bolesti jest ograničena, budući da se ona susreće i u drugim nealergijskim bolestima. Povišene koncentracije speciičnih IgE protutijela, zajedno s pozitivnom anamnezom, indikativne su za klinički značajnu alergijsku bolest. Preporučena laboratorijska metoda za određivanje koncentracije IgE protutijela u serumu jest luoroenzimimunokemijska metoda. Povišene serumske koncentracije IgG protutijela nemaju dokazanu ulogu u dijagnostici alergije na hranu, a mogu poslužiti u procjeni uspješnosti speciične imunoterapije na alergene kukaca te procjeni rizika razvoja anailaksije uzrokovane ovom skupinom alergena. Povišena koncentracija serumske triptaze (podtip ), indikator je degranulacije mastocita uzrokovane speciičnim alergenom. Porast koncentracije eozinoilnog kationskog proteina (EKP) nastupa tijekom kasne faze alergijske reakcije te se može koristiti u praćenju alergijskih i drugih upalnih stanja u kojima eozinoili imaju glavnu ulogu. Test aktivacije bazoilnih (BAT) leukocita temelji se na određivanju staničnih razlikovnih obilježja, CD 63 i CD203c metodom protočne citometrije. BAT je koristan u dijagnostici alergija na alergene kukaca, nutritivnih te medikamentnih alergija. Alergološka dijagnostika temeljena na ekstraktima alergena može se koristiti u monosenzibiliziranih bolesnika s jasnom kliničkom slikom te u bolesnika kojima se planira prepisati samo simptomatska terapija. U suvremenoj su kliničkoj praksi razvijenih zemalja mnogo češći polisenzibilizirani bolesnici s kompleksnom simptomatologijom te sumnjom na križnu reaktivnost. Kod ovih se bolesnika preporuča koristiti molekularnu alergološku dijagnostiku.In vitro diagnostic procedure in allergology includes determination of serum levels of total and allergen speciic IgE antibodies, allergen speciic IgG antibodies, plasma tryptase, eosinophil cationic protein (ECP) and basophil activation test (BAT). In vitro tests should be used according to clinical history, physical examination, and in vivo methods for allergy testing. Clinical relevance of elevated total IgE in allergy diagnosis is modest, since it can be caused by other conditions. Elevated serum levels of allergen speciic IgE antibodies, together with positive medical history, are indicative of clinically relevant allergy. A recommendedlaboratory method for total and speciic IgE concentration measurement is the sandwich-type luoroimmunoassay ImmunoCAP, considered as an ideal immunoassay. Serum levels of allergen speciic IgG antibodies have no proved clinical relevance in food allergy diagnosis. They can be useful to monitor venom immunotherapy success, as well as to estimate the risk of venom induced anaphylaxis. Elevated plasma tryptase (subtype ) level is an indication of mast cell activation caused by speciic allergen. It should be obtained within 4 hours after an anaphylactic episode. Elevated level of ECP can be detected in patient blood during late phase of allergic reaction. It can be used to monitor patients with chronic allergenic and inlammatory conditions in which eosinophils play a central role. BAT includes measurement of CD 63 (cluster of differentiation) and CD 203 antigens of the molecular surface by low cytometry. It is useful in the diagnosis of venom, food and drug allergy, estimation of severity of allergic disease and natural tolerance to allergens. In vitro tests based on allergen extracts can be used for in vitro diagnosis in monosensitized patients with clear medical history and symptomatic treatment. Molecular allergy diagnosis should be performed in special clinical indications such as diagnosis of cross reactivity, prescription of speciic immunotherapy (especially in polysensitized patients with complex symptoms), diagnosis of idiopathic or cofactor induced anaphylaxis, latex allergy, and assessment of the risk of allergic reaction to speciic allergen