Rational Management of Diabetes type 2

Šećerna bolest tipa 2 vrlo je česta bolest kojoj prevalencija progresivno raste s dobi. Uz patofiziologiju i klasifikaciju u članku se razrađuje konvencionalni i intenzivni pristup liječenju. Danas je dostupno pet skupina peroralnih lijekova za regulaciju glikemije. Te su skupine iscrpno prikazane uz naglasak da je uz primjenu lijekova za regulaciju glikemije jednako važno prevenirati komplikacije tog sindroma.Diabetes mellitus type 2 is a common disease whose prevalence progressively rises with age. Besides pathophyisiology and classification the article elaborates the conventional and intensive therapeutic approach. Five orally administered drug groups are today available. These groups are extensively presented emphasizing at the same time the fact that the prevention of complications is equally important as drug taking for regulation of glycaemia

Hormoni i starenje

Since the 19th century, there have been sporadic attempts to attribute the changes of aging to one or another endocrine deficit and efforts to reverse these changes by various replacement therapies. This search for a hormonal ‘fountain of youth’ continues today.Još od 19. stoljeća bilo je sporadičnih pokušaja da se promjene u starenju pripišu nekom endokrinom deficitu, kao i nastojanja da se utječe na te promjene različitim nadomjesnim terapijama. Ta potraga za hormonskim ‘izvorom mladosti’ traje do današnjih dana

Metabolic Insulin Resistance and Purine Metabolism

Metabolički sindrom ili sindrom X nekoliko je međusobno povezanih abnormalnosti koje povećavaju rizik od nastanka kardiovaskularnih i cerebrovaskularnih bolesti. To su dijabetes, hipertenzija, dislipidemija, hiperuricemija, debljina, odnosno bolesti u kojih se na početku patofi ziološkog slijeda nalazi inzulinska rezistencija. S kliničkoga gledišta, hiperuricemija treba upozoriti kliničara na povećani rizik od vaskularnih bolesti. Uloga urične kiseline i njezina povezanost s inzulinskom rezistencijom, kardiovaskularnim i cerebrovaskularnim bolestima, bubrežnim bolestima i hipertenzijom, svaki dan postaje sve važnija i jedan je od esencijalnih čimbenika u kliničkoj evaluaciji i gradiranju fenomena metaboličkog sindroma i dijabetesa tipa 2.Metabolic syndrome or syndrome X is a complex association of several interrelated abnormalities that increase the risk of cardiovascular and cerebrovascular diseases. These diseases include diabetes, hypertension, dyslipidaemia, hyperuricemia, obesity and other diseases resulting from insulin resistance. From a clinical standpoint, hyperuricemia should alert a clinician to an overall increased risk of vascular diseases. The topical role of uric acid and its relation to cardiovascular and cerebrovascular diseases and insulin resistance, renal disease and hypertension is rapidly evolving and it is one of essential factors in the clinical clustering phenomenon of the metabolic syndrome and type 2 diabetes mellitus

Neuroendokrini tumor gušterače s izraženim karcinoidnim sindromom: prikaz slučaja

Carcinoid is the most common neuroendocrine tumor. It is primarily localized in the ileum and the appendix, whereas other localizations are rare. Only a small number of the carcinoids present with carcinoid syndrome (flushing, diarrhea), usually after tumor has already metastasized. A case of carcinoid tumor of uncommon localization is reported. A 54-year-old male patient presented for evaluation because of weight loss, flushing and diarrhea. Laboratory value of 5-HIAA was 775.5 mmol/l (normal values up to 72.8) and the pancreatic tumor marker CA 19-9 was increased. Ultrasonographic and magnetic resonance find-Rings localized the tumor in the prepapillary pancreatic region and visualized the spread to the liver. The diagnosis was confirmed by pathohistologic evaluation of a liver biopsy specimen. The patient was treated with Sandostatin (octreotide analog), which led to significant relief of the symptoms, although control 5-HIAA values were not reduced.Iako su karcinoidi rijetki, predstavljaju najčešći tip neuroendokrinih tumora, primarno smještenih u tankom crijevu i apendiksu. Mali broj ovih tumora, nakon što metastazira u jetru, prezentira se simptomima karcinoidnog sindroma (rumenjača, proljevi). Prikazan je karcinoid gušterače, neuobičajene lokalizacije za ovu vrst tumora. Bolesnik u dobi od 54 godine upuaen je u kliniku zbog gubitka na težini, rumenjače i proljeva. Vrijednosti 5-HIAA i CA 19-9 bile su izrazito povišene. Ultrazvučno i magnetskom rezonancom prikazan je tumor predpapilarnog područja te uvećana jetra prožeta višestrukim sekundarizmima, a patohistološki nalaz govorio je u prilog neuroendokrinog tumora tipa karcinoida. S obzirom na proširenost procesa odustalo se od kirurškog liječenja te je započeta terapija Sandostatinom uza značajno kliničko poboljšanje, no bez učinka na 5-HIAA

Neuroendokrini tumor gušterače s izraženim karcinoidnim sindromom: prikaz slučaja

Carcinoid is the most common neuroendocrine tumor. It is primarily localized in the ileum and the appendix, whereas other localizations are rare. Only a small number of the carcinoids present with carcinoid syndrome (flushing, diarrhea), usually after tumor has already metastasized. A case of carcinoid tumor of uncommon localization is reported. A 54-year-old male patient presented for evaluation because of weight loss, flushing and diarrhea. Laboratory value of 5-HIAA was 775.5 mmol/l (normal values up to 72.8) and the pancreatic tumor marker CA 19-9 was increased. Ultrasonographic and magnetic resonance find-Rings localized the tumor in the prepapillary pancreatic region and visualized the spread to the liver. The diagnosis was confirmed by pathohistologic evaluation of a liver biopsy specimen. The patient was treated with Sandostatin (octreotide analog), which led to significant relief of the symptoms, although control 5-HIAA values were not reduced.Iako su karcinoidi rijetki, predstavljaju najčešći tip neuroendokrinih tumora, primarno smještenih u tankom crijevu i apendiksu. Mali broj ovih tumora, nakon što metastazira u jetru, prezentira se simptomima karcinoidnog sindroma (rumenjača, proljevi). Prikazan je karcinoid gušterače, neuobičajene lokalizacije za ovu vrst tumora. Bolesnik u dobi od 54 godine upuaen je u kliniku zbog gubitka na težini, rumenjače i proljeva. Vrijednosti 5-HIAA i CA 19-9 bile su izrazito povišene. Ultrazvučno i magnetskom rezonancom prikazan je tumor predpapilarnog područja te uvećana jetra prožeta višestrukim sekundarizmima, a patohistološki nalaz govorio je u prilog neuroendokrinog tumora tipa karcinoida. S obzirom na proširenost procesa odustalo se od kirurškog liječenja te je započeta terapija Sandostatinom uza značajno kliničko poboljšanje, no bez učinka na 5-HIAA

Utjecaj novih saznanja i stavova o bolestima na terapijsko odlučivanje liječnika

The aim of the study was to investigate the attitude towards alcoholism and patients with alcoholic cirrhosis, and to assess the knowledge of pathophysiology and treatment of ascites in liver cirrhosis in the physicians from hospitals in Atlanta and Zagreb. Internists and internal medicine residents were asked to fill-out a questionnaire containing 14 questions on the attitude towards alcoholism and patients with alcoholic cirrhosis, and on the knowledge of ascites pathophysiology and treatment. The study was conducted at University Departments of Medicine at Sestre milosrdnice University Hospital and Zagreb University Hospital Center from Zagreb, Croatia (n=40), and Emory School of Medicine from Atlanta, Georgia, USA (n=30). In the Zagreb group, there were significantly more internists (p=0.025) with significantly more years of specialist service (p=0.006). Significant difference between the two groups was recorded in their answers to questions on alcoholism (p=0.006), correct concept of pathophysiology of ascites formation (p<0.001), cardiac output in liver cirrhosis (p<0.001), plasma aldosterone concentration on upright posture test in preascitic liver cirrhosis (p=0.030), atrial natriuretic peptide (p<0.001), therapeutic impact of spironolactone (p=0.005), and paracentesis (p=0.009), as well as in the frequency of correct answers to questions on alcoholism (p=0.002), cardiac output in liver cirrhosis (p=0.001) and plasma aldosterone concentration on upright posture test in preascitic liver cirrhosis (p=0.005), with the Zagreb group scoring worse and, according to sex, also in the knowledge of the century of Leonardo da Vinci\u27s birth (p=0.018). Negative attitude towards alcoholism and alcoholic cirrhosis in the Zagreb respondents, and the lack of knowledge about the basic pathophysiologic mechanism of ascites formation and new treatment algorithms in liver cirrhosis were recorded in both groups. The attitude and knowledge influence treatment decisions. The clinicians\u27 knowledge about the effectiveness of a novel or established treatment protocol including modification in the indications or method and its timing is indispensable.Cilj studije bio je ispitati stav liječnika prema alkoholičarima i bolesnicima s alkoholnom bolešću jetre, te njihovo znanje o patofiziologiji i liječenju ascitesa u jetrenoj cirozi. Internisti i specijalizanti interne medicine su zamoljeni da ispune upitnik sastavljen od 14 pitanja o stavu prema alkoholizmu i alkoholnoj bolesti jetre, patofiziologiji nastanka ascitesa i njegovom liječenju. Istraživanje je provedeno u Klinikama za unutarnje bolesti Kliničke bolnice "Sestre milosrdnice" i Kliničkog bolničkog centra "Zagreb", Hrvatska (n=40) te Emory School of Medicine, Atlanta, Sjedinjene Američke Države (n=30). U skupini liječnika iz Zagreba bilo je statistički značajno više internista (p=0,025) i sa značajno dužim specijalističkim stažem (p=0,006). Značajna je bila razlika među skupinama u odgovorima na pitanja što je: alkoholizam (p=0,006), točna patofiziološka teorija nastanka ascitesa (p<0,001), minutni volumen u jetrenoj cirozi (p<0,001), plazmatska koncentracija aldosterona u testu stajanja u kompenziranoj jetrenoj cirozi (p=0,030), biološki učinak atrijskog natriuretičnog peptida (p<0,001), terapijski učinak spironolaktona (p=0,005) i paracenteza (p=0,009), kao i u učestalosti točnih odgovora na pitanja: alkoholizam je (p=0,002), minutni volumen u jetrenoj cirozi je (p=0,001), u kompenziranoj jetrenoj cirozi, u testu stajanja, aldosteron je (p=0,005) u korist skupine liječnika iz Atlante. Statistički značajno više liječnica iz Zagreba je znalo stoljeće rođenja Leonarda da Vincija (p=0,018). Zabilježili smo negativan stav prema alkoholičarima i bolesnicima s alkoholnom cirozom jetre u skupini liječnika iz Zagreba, te nedostatak znanja o patofiziološkim mehanizmima nastanka ascitesa i novim protokolima njegovog liječenja u objema skupinama. Liječnikov stav i znanje imaju utjecaja na terapijsko odlučivanje. Skraćenje vremena potrebnog za prihvaćanje novih spoznaja o učinkovitosti novih ili etabliranih protokola liječenja s izmjenama u indikacijama ili načinu i vremenu primjene od strane praktičara je neophodno i proporcionalno je sa znanjem

Utjecaj novih saznanja i stavova o bolestima na terapijsko odlučivanje liječnika

The aim of the study was to investigate the attitude towards alcoholism and patients with alcoholic cirrhosis, and to assess the knowledge of pathophysiology and treatment of ascites in liver cirrhosis in the physicians from hospitals in Atlanta and Zagreb. Internists and internal medicine residents were asked to fill-out a questionnaire containing 14 questions on the attitude towards alcoholism and patients with alcoholic cirrhosis, and on the knowledge of ascites pathophysiology and treatment. The study was conducted at University Departments of Medicine at Sestre milosrdnice University Hospital and Zagreb University Hospital Center from Zagreb, Croatia (n=40), and Emory School of Medicine from Atlanta, Georgia, USA (n=30). In the Zagreb group, there were significantly more internists (p=0.025) with significantly more years of specialist service (p=0.006). Significant difference between the two groups was recorded in their answers to questions on alcoholism (p=0.006), correct concept of pathophysiology of ascites formation (p<0.001), cardiac output in liver cirrhosis (p<0.001), plasma aldosterone concentration on upright posture test in preascitic liver cirrhosis (p=0.030), atrial natriuretic peptide (p<0.001), therapeutic impact of spironolactone (p=0.005), and paracentesis (p=0.009), as well as in the frequency of correct answers to questions on alcoholism (p=0.002), cardiac output in liver cirrhosis (p=0.001) and plasma aldosterone concentration on upright posture test in preascitic liver cirrhosis (p=0.005), with the Zagreb group scoring worse and, according to sex, also in the knowledge of the century of Leonardo da Vinci\u27s birth (p=0.018). Negative attitude towards alcoholism and alcoholic cirrhosis in the Zagreb respondents, and the lack of knowledge about the basic pathophysiologic mechanism of ascites formation and new treatment algorithms in liver cirrhosis were recorded in both groups. The attitude and knowledge influence treatment decisions. The clinicians\u27 knowledge about the effectiveness of a novel or established treatment protocol including modification in the indications or method and its timing is indispensable.Cilj studije bio je ispitati stav liječnika prema alkoholičarima i bolesnicima s alkoholnom bolešću jetre, te njihovo znanje o patofiziologiji i liječenju ascitesa u jetrenoj cirozi. Internisti i specijalizanti interne medicine su zamoljeni da ispune upitnik sastavljen od 14 pitanja o stavu prema alkoholizmu i alkoholnoj bolesti jetre, patofiziologiji nastanka ascitesa i njegovom liječenju. Istraživanje je provedeno u Klinikama za unutarnje bolesti Kliničke bolnice "Sestre milosrdnice" i Kliničkog bolničkog centra "Zagreb", Hrvatska (n=40) te Emory School of Medicine, Atlanta, Sjedinjene Američke Države (n=30). U skupini liječnika iz Zagreba bilo je statistički značajno više internista (p=0,025) i sa značajno dužim specijalističkim stažem (p=0,006). Značajna je bila razlika među skupinama u odgovorima na pitanja što je: alkoholizam (p=0,006), točna patofiziološka teorija nastanka ascitesa (p<0,001), minutni volumen u jetrenoj cirozi (p<0,001), plazmatska koncentracija aldosterona u testu stajanja u kompenziranoj jetrenoj cirozi (p=0,030), biološki učinak atrijskog natriuretičnog peptida (p<0,001), terapijski učinak spironolaktona (p=0,005) i paracenteza (p=0,009), kao i u učestalosti točnih odgovora na pitanja: alkoholizam je (p=0,002), minutni volumen u jetrenoj cirozi je (p=0,001), u kompenziranoj jetrenoj cirozi, u testu stajanja, aldosteron je (p=0,005) u korist skupine liječnika iz Atlante. Statistički značajno više liječnica iz Zagreba je znalo stoljeće rođenja Leonarda da Vincija (p=0,018). Zabilježili smo negativan stav prema alkoholičarima i bolesnicima s alkoholnom cirozom jetre u skupini liječnika iz Zagreba, te nedostatak znanja o patofiziološkim mehanizmima nastanka ascitesa i novim protokolima njegovog liječenja u objema skupinama. Liječnikov stav i znanje imaju utjecaja na terapijsko odlučivanje. Skraćenje vremena potrebnog za prihvaćanje novih spoznaja o učinkovitosti novih ili etabliranih protokola liječenja s izmjenama u indikacijama ili načinu i vremenu primjene od strane praktičara je neophodno i proporcionalno je sa znanjem