9 research outputs found
The usefulness of endoscopic ultrasonography in differentiation between benign and malignant gastric ulcer
Background/Aim. Gastric ulcer may be benign or malignant. In terms of therapy
and patientās prognosis early detection of malignancy is very important. The
aim of this study was to assess the usefulness of endoscopic ultrasound (EUS)
in differentiation between benign and malignant gastric ulcer. Methods. A
prospective study included 20 consecutive adult patients with malignant
gastric ulceration and 20 consecutive adult patients with benign gastric
ulceration. All the patients underwent EUS. A total of 6 parameters were
analyzed: ulcer width, ulcer depth, the thickness of the gastric wall along
the edge of ulceration (T0), the thickness of the gastric wall 2 cm from the
edge of ulceration (T2), loss of layering structure of the gastric wall, and
the presence of regional lymph nodes. EUS criteria for malignancy and a
point-score of malignancy were defined. The critical value of total
point-score was also calculated showing the best reliability parameters.
Results. There are 4 criteria for malignancy of gastric ulceration: T0 > 10
mm, T2 > 5 mm, EUS visualization of at least one lymph node, loss of layering
structure of the gastric wall. Furthermore, T2 > 5 mm was the only EUS
independent predictor of ulcer malignancy. The total point score of ā„ 4 was
the cut-off pointscore value which gave the best reliability parameters in
the assessment of malignant ulcers: sensitivity of 70%, specificity of 95%,
positive predictive value of 93.3%, negative predictive value of 76% and
accuracy of 82.5%. Conclusion. According to the results obtained in this
study, we can conclude that EUS is usefull in differentiation between benign
and malignant gastric ulcer
Risk factors for nutritional status determination and indications for preventive nutrition therapy in hospitalized gastroenterological patients
Background/Aim. Risk factors for the intrahospital nutritional status worsening (NSW) have not been precisely defined in the literature. The objective was defining thoese factors among gastroenterological patients and defining the risk patients requiring a preventive nutritional therapy. Methods. In 650 gastroenterological patients, NSW was evaluated on the basis of reducing of the six parameters: body weight, body mass index (BMI), triceps skinfold thickness (TSF), midupper arm muscle circumference (MAMC), serum albumin level (ALB), and lymphocyte count (LYM). The influence on NSW was tested for 13 factors concerning characteristics of the patient, disease, and diagnostic procedures. Among the factors influencing significantly the NSW, primary and secondary risk factors were selected. After scoring of risk factors had been performed, the risk-score for NSW (RSNSW) was defined. The critical value of RSNSW which required preventive nutritional therapy was also calculated. Results. The incidence of NSW was in the range 29.2%ā57.9%. The presence of general complications and severe disease activity were considered as primary risk factors, whereas malignant disease, age above 71, hepato-billiary tract involvement, hospitalization longer than 14 days, and mobility worsening were considered as secondary risk factors. The best predictive value for the NSW was proved for the RSNSW ā„ 6. Because of that, preventive nutritional therapy should be indicated in patients presenting with both primary risk factors or in patients presenting with one primary factor combined with three secondary risk factors at least. Conclusion. There are 7 risk factors for NSW in gastroenterological patients, but they are not of the same importance - two primary and five secondary risk factors can be differentiated. Preventive nutritional therapy is indicated only in patients having both primary risk factors or in those presenting with one primary risk factor combined with three secondary risk factors at least
The impact of in-hospital nutritional status deterioration on treatment outcome of adult gastroenterological patients
Background/Aim. In the current literature, data on impact of intrahospital
changes in patientsā nutritional status on the treatment outcome are limited.
The aim of this study was to investigate the relationship between nutritional
status deterioration and the treatment outcome among hospitalized
gastroenterological patients. Methods. In 650 adult gastroenterological
patients nutritional status on admission and at discharge was evaluated using
the 6 nutritional status assessment parameters: body mass index, triceps
skinfold thickness, mid-upper arm muscle circumference, serum albumin
concentration, lymphocyte count and unintentional weight loss. The influence
on treatment outcome was tested for the nutritional status on admission,
nutritional status at discharge and intrahospital nutritional status
deterioration. Results. The incidence of favorable outcome in the
non-undernourished and undernourished patients on admission was in the range
93.4-97.3% and 81.2- 91.2%, respectively. The incidence of favorable outcome
in the non-undernourished and undernourished patients at discharge was in the
range 94-97.4% and 80.8-88.1%, respectively. Favorable outcomes were obtained
in 95.6-98.9% of the patients without nutritional status deterioration and in
87.1-90.3% of the patients with nutritional status deterioration.
Intrahospital nutritional status deterioration significantly influenced the
outcome, no matter what assessment parameter had been used (p < 0.001 for all
the applied parameters). Furthermore, only the deterioration of nutritional
status was found to be an independent predictor of treatment outcome
(multivariate analysis Forwald Wald, p Ā£ 0.001; relative risk (RR) =
0.104-0.350; confidence intervals (CI) = 0.037-0.186/0.297-0.657).
Conclusion. Deterioration of nutritional status is an independent predictor
of adverse outcome
Hereditary hemorrhagic telangiectasia associated with inherited thrombophilia
Introduction. Hereditary hemorrhagic telangiectasia and inherited
thrombophilia are genetic disorders with quite opposite clinical
manifestation. The main characteristic for hereditary hemorrhagic
telangiectasia is recurrent bleeding, while the main characteristic for
hereditary thrombophilia is thrombosis. The association between hereditary
hemorrhagic telangiectasia and inherited thrombophilia in the same patient is
rare. Case report. We presented a 32-year-old female with recurrent
gastrointestinal hemorrhage and epistaxes, during a 9-year period. Hereditary
hemorrhagic telangiectasia was established according to āCuraƧaoā criteria.
Three of four criteria have been present: spontaneous recurrent epistaxis,
multiple telangiectasias (nose) and visceral lesions (gastric
angiodysplasias, jejunal telangiectasias, arterio- venous jejunal fistula).
Pulmonary thromboembolism was the first manifestation of thrombophilia; the
diagnosis was confirmed by genetic testing. Therapy of hemorrhage with
tranexamic acid (anti-fibrinolytic agent; its use increases risk of
thrombosis) was unsuccessful. Remission was achieved by thalidomide. The
initial therapy for pulmonary thromboembolism included aspirin (that have an
increased risk of bleeding), but aspirin had to be discontinued because of
massive hematemesis. Unfortunately, a year later, anticoagulant therapy
combined with the proton pump inhibitors, were introduced, because of a new
thrombosis. One month after, the patient was still on this therapy, without
new episodes of bleeding and thromboembolic events. Conclusion. Hereditary
hemorrhagic telangiectasia and inherited thrombophilia could be unrecognized
for years, partly due to the lower degree of clinical suspicion. Early
diagnosis and the appropriate choice of therapy are essential for reducing
serious consequences and to improve quality of life
Secondary Traumatization of Wives of War Veterans with Posttraumatic Stress Disorder
Aim: To determine the symptoms of secondary traumatic stress and possible influences of demographic and socioeconomic factors on the occurrence of secondary traumatic stress in wives of war veterans with posttraumatic stress disorder (PTSD).
Method: The study included 56 wives of war veterans diagnosed with PTSD and treated at the Center for Psychotrauma in Rijeka, Croatia. A short structured interview was conducted with each woman to collect demographic and socioeconomic data. The women independently completed an adapted 16-item version of Indirect Traumatization Questionnaire to determine the presence of secondary traumatic stress symptoms, which corresponded with PTSD symptoms as defined by the fourth edition of the Diagnostic and Statistical Manual for Mental Disorders.
Results: Out of 56 veteransā wives included in the study, 32 had six or more symptoms of secondary traumatic stress, whereas only 3 had none of the symptoms. Twenty-two women met the diagnostic criteria for secondary traumatic stress. Women with secondary traumatic stress were married longer than those without it (meanāĀ±āstandard deviation, 19.1āĀ±ā9.1 vs 13.2āĀ±ā7.8 years, respectively; Pā=ā0.016). Eleven of 22 women with secondary traumatic stress and 8 of 34 women without secondary traumatic stress were unemployed (Pā=ā0.05).
Conclusion: As more than a third of war veterans wives met the criteria for secondary traumatic stress, any treatment offered to veterans with PTSD must address the traumatization of their family
Secondary Traumatization of Wives of War Veterans with Posttraumatic Stress Disorder
Aim: To determine the symptoms of secondary traumatic stress and possible influences of demographic and socioeconomic factors on the occurrence of secondary traumatic stress in wives of war veterans with posttraumatic stress disorder (PTSD).
Method: The study included 56 wives of war veterans diagnosed with PTSD and treated at the Center for Psychotrauma in Rijeka, Croatia. A short structured interview was conducted with each woman to collect demographic and socioeconomic data. The women independently completed an adapted 16-item version of Indirect Traumatization Questionnaire to determine the presence of secondary traumatic stress symptoms, which corresponded with PTSD symptoms as defined by the fourth edition of the Diagnostic and Statistical Manual for Mental Disorders.
Results: Out of 56 veteransā wives included in the study, 32 had six or more symptoms of secondary traumatic stress, whereas only 3 had none of the symptoms. Twenty-two women met the diagnostic criteria for secondary traumatic stress. Women with secondary traumatic stress were married longer than those without it (meanāĀ±āstandard deviation, 19.1āĀ±ā9.1 vs 13.2āĀ±ā7.8 years, respectively; Pā=ā0.016). Eleven of 22 women with secondary traumatic stress and 8 of 34 women without secondary traumatic stress were unemployed (Pā=ā0.05).
Conclusion: As more than a third of war veterans wives met the criteria for secondary traumatic stress, any treatment offered to veterans with PTSD must address the traumatization of their family
Erdheim-Chester disease: A case report
Introduction. Erdheim-Chester disease (ECD) is a rare non-Langerhans-cell
histiocytosis. About 500 cases are published so far. It is multisystemic
disease characterised by bilateral symmetric long bones sclerosis. Main
histopathological finding is accumulation of big foamy histiocytes,
immunohistochemically positive to CD68, and negative to S-100 and CD1a. There
are no guidelines that reliably identify population that requires therapy,
but symptomatic ECD, organ failure and central nervous system involvement
re-quire treatment. Case report. We described a patient with a multisystemic
form of ECD affecting long bones, the hypophysis, abdomen, and the peripheral
nerves. Five years after initial symptoms ECD was suspected. Prednison was
initiated, 60 mg once a day. After obtaining the diagnosis of ECD, interferon
alpha 2A was introduced, but soon after stopped due to severe side effects.
Considering that histiocytes were positive to platelet derived growth factor
receptor alpha (PDGFR alpha) imatinib mesylate was started, but after two
months stopped due to no clinical and radiological improvement. The disease
was worsening and the patient died. Conclusion. We described the patient with
intraperitoneal form of ECD, without cardiac and pulmonary involvement. There
are several important issues: the diagnosis of ECD could be difficult to
make, three treatment regimens were included and the patient died nine years
after the initial symptoms due to indolent course of the disease and
unsuccessful treatment
Secondary Traumatization of Wives of War Veterans with Posttraumatic Stress Disorder
Aim: To determine the symptoms of secondary traumatic stress and possible influences of demographic and socioeconomic factors on the occurrence of secondary traumatic stress in wives of war veterans with posttraumatic stress disorder (PTSD).
Method: The study included 56 wives of war veterans diagnosed with PTSD and treated at the Center for Psychotrauma in Rijeka, Croatia. A short structured interview was conducted with each woman to collect demographic and socioeconomic data. The women independently completed an adapted 16-item version of Indirect Traumatization Questionnaire to determine the presence of secondary traumatic stress symptoms, which corresponded with PTSD symptoms as defined by the fourth edition of the Diagnostic and Statistical Manual for Mental Disorders.
Results: Out of 56 veteransā wives included in the study, 32 had six or more symptoms of secondary traumatic stress, whereas only 3 had none of the symptoms. Twenty-two women met the diagnostic criteria for secondary traumatic stress. Women with secondary traumatic stress were married longer than those without it (meanāĀ±āstandard deviation, 19.1āĀ±ā9.1 vs 13.2āĀ±ā7.8 years, respectively; Pā=ā0.016). Eleven of 22 women with secondary traumatic stress and 8 of 34 women without secondary traumatic stress were unemployed (Pā=ā0.05).
Conclusion: As more than a third of war veterans wives met the criteria for secondary traumatic stress, any treatment offered to veterans with PTSD must address the traumatization of their family
Clinical antibacterial effectiveness and biocompatibility of gaseous ozone after incomplete caries removal
ObjectivesTo evaluate local effect of gaseous ozone on bacteria in deep carious lesions after incomplete caries removal, using chlorhexidine as control, and to investigate its effect on pulp vascular endothelial growth factor (VEGF), neuronal nitric oxide synthase (nNOS), and superoxide dismutase (SOD).Materials and methodsAntibacterial effect was evaluated in 48 teeth with diagnosed deep carious lesion. After incomplete caries removal, teeth were randomly allocated into two groups regarding the cavity disinfectant used: ozone (open system) or 2% chlorhexidine. Dentin samples were analyzed for the presence of total bacteria and Lactobacillus spp. by real-time quantitative polymerase chain reaction. For evaluation of ozone effect on dental pulp, 38 intact permanent teeth indicated for pulp removal/tooth extraction were included. After cavity preparation, teeth were randomly allocated into two groups: ozone group and control group. VEGF/nNOS level and SOD activity in dental pulp were determined by enzyme-linked immunosorbent assay and spectrophotometric method, respectively.ResultsOzone application decreased number of total bacteria (p=0.001) and Lactobacillus spp. (p lt 0.001), similarly to chlorhexidine. The VEGF (p lt 0.001) and nNOS (p=0.012) levels in dental pulp after ozone application were higher, while SOD activity was lower (p=0.001) comparing to those in control pulp.ConclusionsAntibacterial effect of ozone on residual bacteria after incomplete caries removal was similar to that of 2% chlorhexidine. Effect of ozone on pulp VEGF, nNOS, and SOD indicated its biocompatibility.Clinical relevanceOzone appears as effective and biocompatible cavity disinfectant in treatment of deep carious lesions by incomplete caries removal technique