Evaluacija potrebe kirurškog liječenja trudnica sa čvorovima u štitnjači i poremećajima rada štitnjače

The incidence of thyroid nodules and thyroid disorders is more common in women. Thyroid nodules are more prevalent with increasing age. It is proven that thyroid nodules and thyroid cancer incidence have been increased in the last three decades. The same period has registered the increase in average age at which women are getting pregnant rising the probability to develop thyroid cancer in pregnancy. Surgery during pregnancy can have a negative impact on both mother and unborn child causing changes in decision making for surgical procedure in pregnant patients with a low risk thyroid cancer. The aim of this review is to identify indications for surgical treatment of the thyroid nodules and thyroid disorders in pregnancy and to establish the most appropriate period of pregnancy to schedule surgery.Čvorovi u štitnjači i poremećaji rada štitnjače učestaliji su u žena. Učestalost pojave čvorova u štitnjači raste sa životnom dobi. Posljednja tri desetljeća porasla je incidencija čvorova u štitnjači kao i karcinoma štitnjače. Istovremeno povećana je i prosječna životna dob u kojoj žene planiraju trudnoću pa je time povećana i incidencija karcinoma štitnjače u trudnoći. Kirurško liječenje za vrijeme trudnoće negativno utječe i na majku i na plod, što potiče mijenjanje strategije u donošenju odluke o operativnom zahvatu u trudnih pacijentica s karcinomom štitnjače. Cilj je ovog pregleda utvrditi apsolutne indikacije za kirurško liječenje čvorova štitnjače u trudnoći i poremećaja rada štitnjače u trudnoći te utvrditi idealno vrijeme u tijeku trudnoće za potreban operativni zahvat

Evaluacija potrebe kirurškog liječenja trudnica sa čvorovima u štitnjači i poremećajima rada štitnjače

The incidence of thyroid nodules and thyroid disorders is more common in women. Thyroid nodules are more prevalent with increasing age. It is proven that thyroid nodules and thyroid cancer incidence have been increased in the last three decades. The same period has registered the increase in average age at which women are getting pregnant rising the probability to develop thyroid cancer in pregnancy. Surgery during pregnancy can have a negative impact on both mother and unborn child causing changes in decision making for surgical procedure in pregnant patients with a low risk thyroid cancer. The aim of this review is to identify indications for surgical treatment of the thyroid nodules and thyroid disorders in pregnancy and to establish the most appropriate period of pregnancy to schedule surgery.Čvorovi u štitnjači i poremećaji rada štitnjače učestaliji su u žena. Učestalost pojave čvorova u štitnjači raste sa životnom dobi. Posljednja tri desetljeća porasla je incidencija čvorova u štitnjači kao i karcinoma štitnjače. Istovremeno povećana je i prosječna životna dob u kojoj žene planiraju trudnoću pa je time povećana i incidencija karcinoma štitnjače u trudnoći. Kirurško liječenje za vrijeme trudnoće negativno utječe i na majku i na plod, što potiče mijenjanje strategije u donošenju odluke o operativnom zahvatu u trudnih pacijentica s karcinomom štitnjače. Cilj je ovog pregleda utvrditi apsolutne indikacije za kirurško liječenje čvorova štitnjače u trudnoći i poremećaja rada štitnjače u trudnoći te utvrditi idealno vrijeme u tijeku trudnoće za potreban operativni zahvat

Unnecessary prescribing of antibiotics to healthy/asymptomatic school-age carriers of potentially pathogenic bacteria

Objectives: To re-draw attention to the unnecessary prescribing of antibiotics. ----- Methods: We monitored nasopharyngeal colonization by 3 potentially pathogenic bacteria, Streptococcus pyogenes, Streptococcus pneumoniae, and Haemophilus influenzae type b in 81 children between the ages of 6 and 7 years who attended the same primary school. The children's health status was also monitored, without using antimicrobial treatment for healthy/asymptomatic carriers. Nasopharyngeal swabs were collected on 6 occasions during autumn months, from mid-September to mid-December 2016. The children who fell ill during the study were treated at the Ear, Nose and Throat Clinic, Sisters of Mercy University Hospital Center, Zagreb, Croatia. ----- Results: Four hundred and sixty-three nasopharyngeal swabs were collected. Each child had at least one positive swab result. Bacterial colonization with Streptococcus pyogenes had the highest colonization rate. During the study, 83% of the children were healthy/asymptomatic carriers with no clinical signs of disease, while 17% became ill. The statistical results showed that the increase in all examined bacteria was statistically significant. ----- Conclusions: Our study results showed that positive bacterial findings in nasopharyngeal swabs from clinically healthy carriers were not an indication for antibiotic therapy

Zarazne bolesti kao hitni slučajevi na dječjem odjelu za bolesti uha, grla i nosa

Infectious diseases are the leading cause of emergency hospital admission for children treated at ENT department. The aim of this retrospective study was to investigate the rate of emergency admission for particular infectious diseases, bacterial etiology and treatment modalities, especially surgical. The study included 83 emergency patients admitted to the Pediatric Division of ENT Department, Sestre milosrdnice University Hospital, Zagreb, over the period from January 1999 through May 2001. In the majority of cases, the pathology was due to upper respiratory tract infections. Otitis media, peritonsillary abscess and acute sinusitis were most common diagnoses. The most frequently isolated pathogenic bacteria were Streptococcus pneumoniae, Haemophilus influenzae and Staphylococcus aureus. All patients were treated with antibiotics and nearly all of them by surgery.Zarazne su bolesti glavna indikacija za hitan prijam na odjel dječje otorinolaringologije. Unatoč tome, broj kliničkih istraživanja koja se bave tom problematikom vrlo je mali. Cilj je ove retrospektivne studije bio istražiti učestalost pojedinih dijagnoza infektivnih bolesti, bakterijsku etiologiju i načine konzervativnog i poglavito kirurškog liječenja djece koja su hitno zaprimljena na Dječji odjel Klinike za otorinolaringologiju i cervikofacijalnu kirurgiju Kliničke bolnice “Sestre milosrdnice” u razdoblju od siječnja 1999. do svibnja 2001. godine. Većina je bolesnika primljena u hitnoj službi. Gotovo su sve dijagnoze povezane s infektivnim upalama gornjih dišnih putova. Najčešća je dijagnoza bila upala srednjeg uha, peritonzilarni apsces i akutni sinusitis. Najčešće izolirane patogene bakterije iz uzetih obrisaka bile su Streptococcus pneumoniae, Haemophilus influenzae i Staphylococcus aureus. Svi su bolesnici liječeni antibioticima, a gotovo svi i kirurški. Najčešće davani antibiotik bio je amoksicilin s klavulonskom kiselinom. Kirurško se liječenje uglavnom temeljilo na pravilu ubi pus ibi evacuo, tako da su najčešći zahvati bile incizije i drenaže, odnosno miringotomija i implantacija ventilacijske cjevčice

Transplantacija larinksa

Laryngeal transplantation is not a new concept. Experiments with reinnervation, revascularisation, immunosupression and preservation started in the late 1950s. The impression after the first successful transplantation was as follows: all expected complications were successfully overcome and the expected failures did not occur. This report will discuss ethical and tehnical considerations of laryngeal transplanatation and risk of cancer reccurrence due to immunosuppression. Laryngeal organ transfer holds the best promise for preserving the quality of life in patients who have lost laryngeal function.Transplantacija larinksa nije neka nova zamisao. Pokusi s reinervacijom, revaskularizacijom, imunosupresijom i očuvanjem započeli su još kasnih 1950-ih. Nakon prve uspješno obavljene transplantacije stekao se dojam da su sve očekivane komplikacije svladane i da se očekivani nedostatci nisu pojavili. U ovom radu razmatrit ćemo etička i tehnička pitanja transplantacije larinksa te opasnost pojave recidiva raka zbog imunosupresije. Transplantacija larinksa najviše obećava kad je riječ o očuvanju kvalitete života bolesnika koji su ostali bez funkcije larinksa

Transplantacija larinksa

Laryngeal transplantation is not a new concept. Experiments with reinnervation, revascularisation, immunosupression and preservation started in the late 1950s. The impression after the first successful transplantation was as follows: all expected complications were successfully overcome and the expected failures did not occur. This report will discuss ethical and tehnical considerations of laryngeal transplanatation and risk of cancer reccurrence due to immunosuppression. Laryngeal organ transfer holds the best promise for preserving the quality of life in patients who have lost laryngeal function.Transplantacija larinksa nije neka nova zamisao. Pokusi s reinervacijom, revaskularizacijom, imunosupresijom i očuvanjem započeli su još kasnih 1950-ih. Nakon prve uspješno obavljene transplantacije stekao se dojam da su sve očekivane komplikacije svladane i da se očekivani nedostatci nisu pojavili. U ovom radu razmatrit ćemo etička i tehnička pitanja transplantacije larinksa te opasnost pojave recidiva raka zbog imunosupresije. Transplantacija larinksa najviše obećava kad je riječ o očuvanju kvalitete života bolesnika koji su ostali bez funkcije larinksa

Stupnjevanje invazivnih stanica - pregled

Pathohistologic diagnosis plays a pivotal role in therapeutic modalities for cancer, and acts as a prognostic factor. The histologic grade is a numeric expression of tumor differentiation and is linked to patient outcome. Broders\u27 scoring system is still widely used in scoring squamous cell carcinomas. New data suggest that in the most invasive parts of a malignant tumor, the morphology and biologic behavior differ from the central and superficial areas of the same tumor. A new invasive cell grading system has been proposed as a better prognostic factor in the multifactorial diagnostic and therapeutic approach to the patient with malignant tumor. Numerous studies performed to date have provided sufficient evidence to propose the invasive cell grading system to be introduced instead of the "old" Broders\u27 scoring system.Patohistološka dijagnoza igra ključnu ulogu u terapijskom pristupu raku te djeluje i kao prognostički čimbenik. Histološki stupanj je brojčani izražaj diferencijacije tumora i vezan je uz prognozu tumorske bolesti u pojedinog bolesnika. Danas je u širokoj uporabi Brodersov sustav histološkog stupnjevanja u karcinomima pločastog epitela. Noviji podatci ukazuju na to da se morfologija i biološko ponašanje stanica u invazivnim dubokim dijelovima malignog tumora razlikuju od središnjih i površinskih dijelova istoga tumora. Novi sustav ICG (invasive cell grading . stupnjevanje invazivnih stanica) predložen je kao bolji prognostički čimbenik u složenom dijagnostičkom i terapijskom pristupu bolesniku s malignim tumorom. Brojna su istraživanja potvrdila da se novi sustav ICG može s dovoljnom sigurnošću rabiti u patohistološkom stupnjevanju malignih tumora umjesto "starog" Brodersovog načina

Strategije u liječenju keloida i hipertrofičnih ožiljaka

Keloids and hypertrophic scars are the consequence of excessive collagen deposition during the process of wound healing. The increasing number of operations and injuries, the widely accepted culture of piercing, and higher cosmetic criteria have led to a greater interest in the methods of their treatment. Due to the lack of an appropriate animal model, the respective research is based solely on clinical experience. A great number of therapeutic options indicate that no ideal therapy has yet been found. Use of multiple modalities is often necessary to treat the lesions successfully. The molecular, biochemical and clinical features of keloids and hypertrophic scars as well as treatment modalities are discussed.Keloidi i hipertrofični ožiljci posljedica su prekomjernog odlaganja kolagena tijekom cijeljenja rane. S povećanim brojem operacija i ozljeda, pojavom tzv. piercinga, te višim estetskim kriterijima poraslo je zanimanje za njihovo liječenje. Nedostatak životinjskog modela za proučavanje keloida upućuje na nužnost iskustva iz klinike prakse. Terapija treba biti kombinirana, a postojanje različitih opcija dokazuje kako još uvijek ne postoji idealan oblik liječenja. Raspravlja se o molekularnim, biokemijskim i kliničkim vidovima razvoja keloida i hipertrofičnih ožiljaka, kao i o njihovom liječenju