Pregled komplikacija kirurških zahvata na štitnjači

The most obvious indication for thyroid surgery is malignancy, but other indications are also not rare. As with any other surgical procedure, those surgeries also carry risks which can be classified as minor or major. Discussion: In this overview, we present minor (seroma, scarring) and major complications of thyroid surgery (recurrent nerve injury, hypoparathyroidism, and bleeding). We discuss the possibilities of prevention and treatment of each of those complications. Conclusion: In recent years, thyroid surgery is becoming safer due to the development of new surgical, hemostatic, and other techniques such as intraoperative monitoring of the recurrent laryngeal nerve and parathyroid gland detection.Najočitija indikacija za kirurški zahvat na štitnjači je zloćudna novotvorina, ali nisu rijetke ni druge indikacije. Kao kod svake druge operacije i ovdje su mogući određeni rizici, koji se mogu podijeliti na blaže i teže. Rasprava: u ovom pregledu predstavljamo blaže (serom, ožiljke i disfagiju) i teže komplikacije kirurgije štitnjače (krvarenje, ozljeda povratnog živca i hipoparatiroidizam). Opisane su mogućnosti prevencije te liječenja svake pojedine komplikacije. Zaključak: u posljednje vrijeme kirurgija štitnjače postaje sve sigurnija, uz uvođenje novijih metoda hemostaze, kao i ostalih metoda poput intraoperativnog monitoringa povratnog živca i detekcije paratiroidnih žlijezda

Suvremeno kirurško liječenje raka rektuma

Surgical treatment is a method of choice in treating patients with resectable primary form of rectal cancer. An important step in treatment is the multidisciplinary approach from different medical specialties in the fields of radiology, gastroenterology, oncology and surgery. In recent years, several minimally invasive surgical procedures have been developed that improve postoperative recovery while still preserving oncological principles, such as laparoscopic low anterior resection, transanal total mesorectal excision and robotic surgery. Surgical and oncological principles that must be respected in all cases are wide resection of the tumor with histologically free resection margins and the use of total mesorectal excision with anal sphincter preservation and preservation of the continuity of the intestine whenever possible.Kirurgija je metoda izbora u liječenju bolesnika s resektabilnim rakom rektuma. Važan korak u liječenju je multidisciplinarni pristup različitih medicinskih specijalnosti iz područja radiologije, gastroenterologije, onkologije i kirurgije. U posljednjih nekoliko godina razvijeno je nekoliko minimalno invazivnih kirurških postupaka s ciljem poboljšanja postoperativnog oporavka uz očuvanje svih onkoloških principa, kao što su laparoskopske niske prednje resekcije, transanalne totalne mezorektalne resekcije i robotske operacije. Kirurška i onkološka načela koja se moraju poštivati u svim slučajevima su široka resekcija tumora s histološki slobodnim resekcijskim rubovima i totalna mezorektalna ekscizija s očuvanjem analnog sfinktera kao i očuvanje kontinuiteta crijeva kad god je to moguće

Silicon foil patching for blast tympanic membrane perforation: a retrospective study

Aim: To establish whether covering the tympanic membrane perforation after war blast injury with silicon foil can enhance the ear drum healing rate and to determine the appropriate timing of silicon patching. ----- Methods: We retrospectively analyzed the charts of 210 patients wounded during the Homeland War in Croatia 1991-1995, with 315 blast tympanic membrane perforations. In 44 patients (61 perforations), the eardrum perforation was covered by silicon foil, whereas in 166 patients (254 perforations) it was left to heal spontaneously. The patients who underwent the patching procedure were divided in two groups according to the time period between the blast injury and the procedure: 38 perforations were treated within 3 days and 23 perforations were treated 4 to 6 days after the blast injury. ------ Results: The rate of tympanic membrane healing in the silicon foil patching group was significantly higher (91.8%) than that in the group of perforations left to heal spontaneously (79.9%, P = 0.029). The healing rate was significantly higher in the group treated within 3 days after the blast injury (97.4%) than in the group treated 4 to 6 days after the injury (82.6%, P = 0.042). ----- Conclusion: Covering the perforation after the war blast injury with silicon foil significantly improves the rate of tympanic membrane healing. To obtain the best healing outcome, the procedure should be performed within the first 72 hours after the trauma

The effects of company characteristics on financial reporting quality – the application of the machine learning technique

Purpose: The paper aims to determine the level of financial reporting quality (FRQ) in listed companies in Croatia, as an example of a macro-based accounting system with an underdeveloped capital market, and identify company characteristics that affect it. The paper systematizes the existing key knowledge of FRQ. Furthermore, it critically analyses the principles and direction of influence of various qualitative and quantitative as well as financial and non-financial characteristics of a company. Methodology: The empirical analyses involve joint testing of the machine learning technique (MLT) and the economic hypotheses. M5 algorithm is applied to identify the factors that influence the quality of voluntary reporting as well as the direction and intensity of their influence. Results: The results show that profitability, stock market listing duration (in years), and company size positively affect the level and extent of FRQ through voluntary disclosure of information in the annual financial reports of Croatian listed companies. In addition, differences in FRQ between different areas of economic activity and depending on the type of auditor were found. Conclusion: Croatian companies should adopt good reporting practices to meet the requirements of the global market and thus contribute to the improvement of the overall transparency system. The same is expected from the relevant regulatory authorities who should encourage full disclosure. The paper provides several scientific contributions: first, the spatial dimension of the research; second, the comprehensive literature review; and third, the MLT application in the research on FRQ. An important practical implication of these findings is that they will help financial statement users in the economic decision-making process

Disekcije vrata kod karcinoma usne šupljine

Karcinom usne šupljine metastazira limfnim putem u regionalne limfne čvorove, tako da liječenje metastaza mora bili uključeno u plan liječenja kod većine bolesnika. Prisutnost kliničkih metastaza na vratu najvažniji je prognostički čimbenik u bolesnika s karcinomom usne šupljine, te je poznat podatak da ta činjenica smanjuje ukupno preživljenje za oko 50%. Kod pozitivnog nalaza metastaza na vratu kirurško liječenje je poznato i primjenjuje se neka vrsta modificirane ili klasične radikalne disekcije vrata, ovisno o lokalnom nalazu i TNM stadiju bolesti. S druge strane, liječenje klinički negativnog vrata još uvijek izaziva brojne kontraverze. Uobičajeni stav je da je elektivni tretman na vratu nužan ukoliko je velika vjerojatnost za postajanje okultnih metastaza, zatim ukoliko se vratu ionako pristupa radi odstranjenja primarnog tumora ili ukoliko je procjena da bolesnik nije pouzdan za redovita praćenja nakon završetka liječenja. Ukoliko je primarni tumor mali (T1-2) i odstranjuje se transoralnim pristupom bez otvaranja vrata, a vjerojatnost prisutnosti okultnih metastaza na vratu je mala, tada se može primijeniti metoda čekanja i redovitog praćenja bolesnika. Prema podacima iz literature dilema između elektivne disekcije i čekanja nije do kraja razjašnjena kod bolesnika s ranim stadijem karcinoma, odnosno ne postoje jasne prednosti kirurškoga liječenja. Prednosti elektivnog kirurškog tretmana temelje se na činjenici da je okultna metastaza na vratu u neizbježnom razvoju u kliničku metastazu, te je liječenje jednostavnije i onkološki sigurnije u ranoj fazi bolesti. Nedostaci elektivnog kirurškog tretmana sastoje se u tome da velik broj bolesnika nije trebao takvu vrstu liječenja za potencijalno okultne metastaze na vratu, te da takav zahvat donosi brojne potencijalne komplikacije, prije svega u funkciji ramenog obruča, a zbog ozljede akcesornog živca. Glavno pitanje koje i dalje ostaje uz primjenu svih suvremenih dijagnostičkih metoda, koji bolesnik treba, a koji ne treba elektivni tretman s obzirom na potencijal razvoja metastaza kod bolesnika s karcinomom usne šupljine

UTJECAJ VRSTE REVIZORA I PODRUČJA DJELATNOSTI NA DOBROVOLJNO IZVJEŠTAVANJE U HRVATSKOJ

Cilj je ovog rada istražiti utjecaj dvaju obilježja, vrste revizora (Velika četvorka ili ostali revizori) i područja djelatnosti na kvalitetu dobrovoljnog izvještavanja u Hrvatskoj. Istraživanje je provedeno na uzorku od 30 trgovačkih društava koja su kotirala na Zagrebačkoj burzi u razdoblju od 2009. do 2013. godine, a kvaliteta dobrovoljnog izvještavanja ocijenjena je metodom nevaganih indeksa. Dobiveni rezultati pokazuju da u godišnjim izvještajima postoji statistički značajna razlika u kvaliteti dobrovoljnog izvještavanja s obzirom na vrstu revizora i područja djelatnosti u kojima društva posluju. Dokazano je da društva koja revidira Velika četvorka objavljuju kvalitetniji godišnji izvještaj, aproksimirano količinom objavljenih informacija o poslovanju. Također, utvrđena je razlika između društava koja posluju u različitim područjima djelatnosti s obzirom na kvalitetu dobrovoljnog izvještavanja, pri čemu je utvrđeno da najkvalitetnije godišnje izvještaje imaju društva koja posluju u djelatnosti informacije i komunikacije, a najmanju kvalitetu godišnjih izvještaja imaju društva koja posluju u djelatnosti pružanja smještaja te pripreme i usluživanja hrane

Disekcije vrata kod karcinoma usne šupljine

Karcinom usne šupljine metastazira limfnim putem u regionalne limfne čvorove, tako da liječenje metastaza mora bili uključeno u plan liječenja kod većine bolesnika. Prisutnost kliničkih metastaza na vratu najvažniji je prognostički čimbenik u bolesnika s karcinomom usne šupljine, te je poznat podatak da ta činjenica smanjuje ukupno preživljenje za oko 50%. Kod pozitivnog nalaza metastaza na vratu kirurško liječenje je poznato i primjenjuje se neka vrsta modificirane ili klasične radikalne disekcije vrata, ovisno o lokalnom nalazu i TNM stadiju bolesti. S druge strane, liječenje klinički negativnog vrata još uvijek izaziva brojne kontraverze. Uobičajeni stav je da je elektivni tretman na vratu nužan ukoliko je velika vjerojatnost za postajanje okultnih metastaza, zatim ukoliko se vratu ionako pristupa radi odstranjenja primarnog tumora ili ukoliko je procjena da bolesnik nije pouzdan za redovita praćenja nakon završetka liječenja. Ukoliko je primarni tumor mali (T1-2) i odstranjuje se transoralnim pristupom bez otvaranja vrata, a vjerojatnost prisutnosti okultnih metastaza na vratu je mala, tada se može primijeniti metoda čekanja i redovitog praćenja bolesnika. Prema podacima iz literature dilema između elektivne disekcije i čekanja nije do kraja razjašnjena kod bolesnika s ranim stadijem karcinoma, odnosno ne postoje jasne prednosti kirurškoga liječenja. Prednosti elektivnog kirurškog tretmana temelje se na činjenici da je okultna metastaza na vratu u neizbježnom razvoju u kliničku metastazu, te je liječenje jednostavnije i onkološki sigurnije u ranoj fazi bolesti. Nedostaci elektivnog kirurškog tretmana sastoje se u tome da velik broj bolesnika nije trebao takvu vrstu liječenja za potencijalno okultne metastaze na vratu, te da takav zahvat donosi brojne potencijalne komplikacije, prije svega u funkciji ramenog obruča, a zbog ozljede akcesornog živca. Glavno pitanje koje i dalje ostaje uz primjenu svih suvremenih dijagnostičkih metoda, koji bolesnik treba, a koji ne treba elektivni tretman s obzirom na potencijal razvoja metastaza kod bolesnika s karcinomom usne šupljine

Anatomical and clinical features of Mladina type 6 nasal septum deformation and its impact on speech and hearing performances

Aim: The aim of this study was to detect the frequency of type 6 deformation overall compared to the results obtained by the conventional diagnostic method and to determine if there was a difference according to this deformation type in speech and hearing performances. Methods: The study was performed at the Institute of Anatomy, where a total of 114 randomly selected skulls were scanned by the cone-beam technique (CBCT). The other group of 100 patients, 50 with and 50 without type 6 deformation was examined by ORL and speech therapists at the ORL HNS Department to determine if there was a significant deterioration in speech and hearing performances between those groups. Results: There was a statistically significant difference (p<0.0001) in the frequency of type 6 deformation as diagnosed by visual inspection (22.8%) and computed tomography (7.9%). No statistically significant difference was found between the two groups of patients with or without type 6 deformation in speech and hearing performances according to the patient’s age and sex. Conclusions: The frequency of type 6 nasal septal deformation was higher by visual inspection of the skulls than by CT imaging. Septal deformation type 6, probably have one-fourth to one-fifth people in the population, so the number of clinically overlooked and/or unrecognized types 6 was much greater than we thought it to be. According to a high frequency of those deformations, we explored if there was a deterioration in speech and hearing performances in those patients but we did not find significant difference according to the patient’s age and sex

Anatomical and clinical features of Mladina type 6 nasal septum deformation and its impact on speech and hearing performances

Aim: The aim of this study was to detect the frequency of type 6 deformation overall compared to the results obtained by the conventional diagnostic method and to determine if there was a difference according to this deformation type in speech and hearing performances. Methods: The study was performed at the Institute of Anatomy, where a total of 114 randomly selected skulls were scanned by the cone-beam technique (CBCT). The other group of 100 patients, 50 with and 50 without type 6 deformation was examined by ORL and speech therapists at the ORL HNS Department to determine if there was a significant deterioration in speech and hearing performances between those groups. Results: There was a statistically significant difference (p<0.0001) in the frequency of type 6 deformation as diagnosed by visual inspection (22.8%) and computed tomography (7.9%). No statistically significant difference was found between the two groups of patients with or without type 6 deformation in speech and hearing performances according to the patient’s age and sex. Conclusions: The frequency of type 6 nasal septal deformation was higher by visual inspection of the skulls than by CT imaging. Septal deformation type 6, probably have one-fourth to one-fifth people in the population, so the number of clinically overlooked and/or unrecognized types 6 was much greater than we thought it to be. According to a high frequency of those deformations, we explored if there was a deterioration in speech and hearing performances in those patients but we did not find significant difference according to the patient’s age and sex