41 research outputs found
Teriparatide - new value in osteoporosis treatment: treatment guidelines
Osteoporoza je postala globalni zdravstveni problem, zbog produljenja životnog vijeka i sve veÄe zastupljenosti ljudi starije dobi u populaciji. Veliki napredak je uÄinjen u lijeÄenju postmenopauzalne osteoporoze. Lijekovi za lijeÄenje osteoporoze se prema mehanizmu djelovanja dijele na antiresorptive i anabolike. Teriparatid je osteoanaboliÄki lijek koji stimulira koÅ”tanu pregradnju i stvaranje nove kosti, namijenjen je lijeÄenju žena u postmenopauzi s multiplim osteoporotiÄnim prijelomima.Osteoporosis has become global health issue due to the longer life-cycle and increased percentage of older people in population. The great improvement was done in the treatment of postmenopausal osteoporosis. By the mechanism of action, drugs for osteoporosis treatment are antiresorptives and osteoanabolics. Teriparatide is an osteoanabolic drug that stimulates bone turnover and building of a new bone, indicated for treatment of women in postmenopause with multiple osteoporotic fractures
CLINICAL EVALUATION OF GYNECOMASTIA
Ginekomastijom nazivamo poveÄanje dojke u muÅ”karaca uzrokovano proliferacijom žljezdanog tkiva. Posljedica je poremeÄenog omjera estrogena i androgena u plazmi ili lokalno u žljezdanom tkivu dojke. Uzroci ginekomastije uglavnom su benigni. FizioloÅ”ka ginekomastija Äesta je pojava i nalazimo ju u novoroÄenÄadi, u pubertetu i u starijoj dobi. NefizioloÅ”ka ginekomastija može nastati kao posljedica raznih kroniÄnih bolesti (npr. hipogonadizam, ciroza jetre, zatajenje bubrega), upotrebe lijekova ili drugih tvari i, rijetko, tumora. Obradu zapoÄinjemo pažljivim uzimanjem anamneze i fizikalnim pregledom, nakon Äega, prema potrebi, obradu proÅ”irujemo ciljanim radioloÅ”kim i laboratorijskim pretragama. Terapija ginekomastije temelji se na lijeÄenju bolesti koja ju je uzrokovala, odnosno prekidu primjene lijekova/tvari koji su je potencijalno izazvali.Gynecomastia is characterized by the ennlargement of the male breast caused by glandular proliferation. Gynecomastia occurs when the estrogen-to-androgen ratio is disrupted, in plasma or locally in the breast tissue. The etiology is usually benign. Physiologic gynecomastia is common in newborns, adolescents, and older men. Nonphysiologic gynecomastia may be caused by chronic conditions (e.g. hypogonadism, liver cirrhosis, renal insufficiency), use of certain medications or substances, and, rarely tumors. The diagnostic evaluation starts with careful history taking and physical examination which may be followed by extensive work-up that includes selective imaging and laboratory testing. Discontinuing the use of contributing medications and treating the underlying disease are the mainstay of treatment
Raloxifene (EvistaĀ®) in the treatment of postmenopausal osteoporosis - the profile of the patient
Osteoporoza je uz bolesti dojke i srÄanožilnog sustava, jedan od vodeÄih zdravstvenih problema žena u postmenopauzi. Nekoliko razliÄitih terapijskih opcija, ukljuÄujuÄi hormonsko nadomjesno lijeÄenje (HNL), bisfosfonate, kalcitonin i selektivne modulatore estrogenih receptora, omoguÄuje uspjeÅ”no lijeÄenje ove bolesti. Ipak, buduÄi da je dugotrajna primjena HNL povezana s neželjenim uÄincima kao Å”to su vaginalno krvarenje i rak dojke, a bisfosfonati, osim na kost, nemaju uÄinak na druge sustave, raloksifen, kao prvi SERM druge generacije, predstavlja znaÄajan napredak u lijeÄenju postmenopauzalnih žena. Ovisno o tkivu, SERM-ovi djeluju agonistiÄki (kost) odnosno antagonistiÄki (dojka) estrogenu. Primjena raloksifena prevenira gubitak kosti, smanjuje uÄestalost vertebralnih prijeloma u žena s ili bez prethodnog prijeloma, smanjuje uÄestalost invazivnog, estrogen-receptor pozitivnog, raka dojke, a Äini se da smanjuje i uÄestalost kardiovaskularnih dogaÄaja u žena s poviÅ”enim rizikom. Nedavno su objavljeni rezultati studije CORE koji su potvrdili rezultate prethodnih studija u pogledu uÄinka raloksifena na rak dojke, dok se podaci o uÄinku na koÅ”tani sustav nakon 8 godina primjene raloksifena oÄekuju u najskorijoj buduÄnosti. Dodatne informacije o uÄinkovitosti i sigurnosnom profilu raloksifena pružiti Äe studije RUTH i STAR.Osteoporosis, breast cancer and cardiovascular diseases are major health problems among postmenopausal women. Several pharmacologic options for treatment of osteoporosis are available, including hormone replacement therapy (HRT), bisphosphonates, calcitonin and selective estrogen receptor modulators. However, long-term HRT is associated with unwanted side effects such as vaginal bleeding and breast cancer and bisphosphonates, besides bone, have no other benefits. Therefore, raloxifene, the first of the second-generation of SERMs represents a significant improvement in the treatment of postmenopausal women. It could have either estrogen agonist (bone) or antagonist (breast) activity according to the type of estrogen-responsive tissue. Raloxifene prevents bone loss, reduces the number of vertebral fractures in women with and without prevalent vertebral fractures, induces reduction of estrogen-receptor positive invasive breast cancer and has potential beneficial effect on cardiovascular diseases in women with high risk. CORE study, that was recently published, confirmed previously observed reduction of invasive breast cancer in women treated with raloxifene (MORE study), while the data on skeletal effects after 8-years treatment with raloxifene will be published in the near future. Further studies (RUTH, STAR) will provide additional information on efficacy and safety of raloxifene
KliniÄki pristup ginekomastiji [Clinical evaluation of gynecomastia]
Gynecomastia is characterized by the ennlargement of the male breast caused by glandular proliferation. Gynecomastia occurs when the estrogen-to-androgen ratio is disrupted, in plasma or locally in the breast tissue. The etiology is usually benign. Physiologic gynecomastia is common in newborns, adolescents, and older men. Nonphysiologic gynecomastia may be caused by chronic conditions (e.g. hypogonadism, liver cirrhosis, renal insufficiency), use of certain medications or substances, and, rarely tumors. The diagnostic evaluation starts with careful history taking and physical examination which may be followed by extensive work-up that includes selective imaging and laboratory testing. Discontinuing the use of contributing medications and treating the underlying disease are the mainstay of treatment
Tjelesna aktivnost u prevenciji osteoporoze
Na gustoÄu kosti utjeÄu dob, spol, hormonske promjene, genetski i okoliÅ”ni faktori. Najvažniji okoliÅ”ni faktori su: unos kalcija i vitamina D, zatim izloženost suncu, puÅ”enje i tjelesna aktivnost. Tijekom djetinjstva i adolescencije poveÄava se koÅ”tana masa, a odrasloj i starijoj dobi dolazi do njezinog postupnog fizioloÅ”kog smanjenja. NajznaÄajnije mjere u prevenciji osteoporoze su postizanje Å”to veÄe vrÅ”ne koÅ”tane mase u mladosti i njezino oÄuvanje tijekom života. Tjelesnom aktivnosti poveÄava se koÅ”tana masa, a s njom i snaga i gibljivost miÅ”iÄa Å”to smanjuje rizik od padova i prijeloma. Utjecaj tjelesne aktivnosti na poveÄanje koÅ”tane mase ovisan je o dobi i najintenzivniji je u periodu rasta. Da bi mehaniÄki podražaj poveÄao koÅ”tanu masu, potrebno je da bude naizmjeniÄan i intenzivan te da istovremeno postoji adekvatan unos kalcija i kalorija u organizam. Djeca koja su fiziÄki aktivnija i koja se rekreativno bave odreÄenim sportovima imaju veÄu koÅ”tanu masu u odnosu na ostale vrÅ”njake. Sportovi u kojima se skaÄe, opire o podlogu ili podiže teret poput gimnastike, trÄanja i dizanja utega znaÄajnije poveÄavaju koÅ”tanu masu. Brojna istraživanja na vrhunskim sportaÅ”ima pokazala su da sportaÅ”i imaju znaÄajno veÄu mineralnu gustoÄu kosti u odnosu na
nesportaÅ”e. Nakon 40. godine života koÅ”tana se masa prosjeÄno smanjuje za oko 0,5 % do 1,5 % godiÅ”nje. Gubitak koÅ”tane mase javlja se brže ako nema nikakvoga mehaniÄkog optereÄenja na kost. Brojne studije pokazuju povoljan uÄinak tjelesne aktivnosti na smanjenje gubitka mineralne gustoÄe kosti u odrasloj dobi.
Osim održavanja mineralne gustoÄe kosti, tjelesna aktivnost u starijoj životnoj dobi ima dodatnu važnost jer poveÄava miÅ”iÄnu snagu i ravnotežu. Preporuke za provoÄenje tjelesne aktivnosti odnose se na sve dobne skupine i nemaju dobni limit. Uz to je važno osobama starije životne dobi savjetovati vježbe koordinacije i ravnoteže kao važnih mjera u prevenciji padova.Bone mineral density (BMD) is influenced by gender, age, hormonal changes, and genetic and environmental factors. Nutrition, calcium intake, sun exposure, smoking, and physical activity represent the most important environmental factors infl uencing BMD. Bone mass is gained during childhood and adolescence and gradually declines in adulthood. The two generally accepted strategies in the prevention of osteoporosis are maximising BMD gain in the first three decades of life and minimising age-related bone loss. Evidence shows that growing bone is more responsive to mechanical load than mature bone. To produce adaptive bone response and improve bone mass, mechanical stimulation has to be dynamic, intermittent, and intensive. Simultaneously, abundant availability of nutrient energy, calcium, and vitamin D has to be present. Children who exercise have higher bone mass than their other counterparts. Athletes have higher bone mass than non-athletes. Weight-bearing exercises like gymnastics, running, and weight-lifting have the highest impact on bone mass accrual. In adulthood, bone mass gradually decreases by 0.5-1.5 % per year. In that period of life, the principal strategy for preventing osteoporosis is based on maintaining bone mass and attenuating age-related bone loss. Bone loss occurs more rapidly if there is no mechanical load on the bone. Besides improving BMD in older age, exercise may improve muscular strength and balance
and reduce the risk of falls. Recommendations for physical activities are not age-limited. Besides the weight-bearing activities like gymnastics, tennis, climbing, and running, which are essential for preserving bone mass, elderly individuals are advised to perform the activities designed to improve coordination and balance and prevent falls
Traumatska optiÄka neuropatija ā prikaz sluÄaja s raspravom o dijagnostiÄkim postupcima i lijeÄenju
Traumatic optic neuropathy (TON) is a serious vision threatening condition that can be caused by ocular or head trauma. Indirect damage to the optic nerve is the most common form of TON occurring in 0.5% to 5% of all closed head trauma cases. Although the degree of visual loss after indirect TON may vary, approximately 50% of all patients are left with ālight perceptionā or āno light perceptionā vision, making TON a significant cause of permanent vision loss. We present a 47-year-old male patient with a history of right eye keratoconus following a motorcycle crash. Visual acuity was of ācounting fingers at 2 metersā on the right eye due to keratoconus and ācounting fingers at 1 meterā on the left eye as a consequence of trauma. The Octopus visual field showed diffuse reduction in retinal sensitivity and the Ishihara color test indicated dysfunction of color perception on the left eye. Relative afferent pupillary defect was also present. Computed tomography revealed multifragmentary fracture of the frontal sinus and the roof of the left orbit without bone displacement. Based on the findings, conservative corticosteroid therapy without surgery was conducted. The patient responded well to treatment with complete ophthalmologic recovery.Traumatska optiÄka neuropatija (TON) može biti uzrokovana traumom oka ili glave i predstavlja ozbiljno stanje koje može ugrožavati vidnu funkciju. Indirektno oÅ”teÄenje oÄnoga živca je najÄeÅ”Äi oblik TON-a, a javlja se u 0,5% do 5% sluÄajeva svih zatvorenih trauma glave. Iako stupanj gubitka vida nakon indirektne traume vidnoga živca može varirati, u oko 50% svih bolesnika vidna oÅ”trina je smanjena na āosjeÄaj svjetlaā ili ābez osjeÄaja svjetlaā, zbog Äega TON predstavlja znaÄajan uzrok trajnog gubitka vida. Prikazan je sluÄaj 47-godiÅ”njeg bolesnika s povredom vidnoga živca nakon motociklistiÄke prometne nezgode. Vidna oÅ”trina na desnom oku bila je ābrojanje prstiju na 2 metraā, zbog otprije postojeÄeg keratokonusa i ābrojanje prstiju na 1 metarā na lijevom oku kao posljedica traume. Nalaz vidnoga polja Octopus pokazao je difuzno smanjenje osjetljivosti mrežnice, a test Ishihara za boje ukazao je na poremeÄaj osjeta boja na lijevom oku uz prisutnost relativnog aferentnog pupilarnog defekta. Kompjutorizirana tomografija pokazala je multifragmentne frakture frontalnog sinusa i krova lijeve orbite bez pomaka kostiju. Na temelju kliniÄke slike i nalaza provedeno je uspjeÅ”no konzervativno lijeÄenje kortikosteroidima s potpunim oftalmoloÅ”kim oporavkom
Epidemiology of Osteoporosis
U veÄini zemalja u svijetu, pa tako i u Hrvatskoj ne postoji jedinstveni sustav registriranja oboljelih od osteoporoze, kao ni osoba s osteoporotskim prijelomima. Podatci iz epidemioloÅ”kih istraživanja pokazuju da je uÄestalost osteoporoze veÄa u azijskim zemljama u odnosu na europsko i sjevernoameriÄko stanovniÅ”tvo bijele rase, u kojih prevalencija iznosi 10 % do 15 %. U Hrvatskoj je uÄestalost sliÄna onoj u drugim europskim zemljama, dok je incidencija osteoporotskih prijeloma neÅ”to veÄa od europskog prosjeka. TakoÄer je broj prijavljenih sluÄajeva osteoporoze i osteomalacije od primarne zdravstvene zaÅ”tite zadnjih 10 godina u stalnom porastu i u 2004. godini je iznosio 0,70 % u odnosu na ukupan broj prijavljenih bolesti. Najvažniji riziÄni Äimbenici bolesti su dob, naslijeÄe, životne navike, postojanje kroniÄnih bolesti i hormonskih poremeÄaja te individualna fizikalna obilježja kosti. Kao u veÄine kroniÄnih bolesti, mjerama prevencije može se pravodobno sprijeÄiti nastanak bolesti i njezinih komplikacija.In many countries, including Croatia, there is no disease registry for osteoporosis and osteoporotic fractures. Epidemiological data show that the prevalence of osteoporosis is much higher in Asian people than in white European or North American populations, where the prevalence ranges between 10 % and 15 %. Epidemiological characteristics of osteoporosis in Croatia are similar to other European countries, though the incidence of osteoporotic fractures is somewhat higher. According to the annual report of registered diseases, the number of patients with osteoporosis and osteoporotic fractures increased during the last 10 years. In 2004, 0.70 % of all registered diseases in Croatia referred to osteoporosis and osteomalacia. The most important risk factors for osteoporosis are age, heredity, lifestyle, chronic diseases, hormonal abnormalities and physical characteristics of bone. Like in other chronic diseases, prevention measures are most important for disease control
Termografija skrotuma u procjeni ishoda operacije varikokele: prikaz sluÄaja
Scrotal thermography is a diagnostic method for varicocele. In short, there are five
diagnostic thermographic criteria for varicocele, i.e., pattern of scrotal thermographic image indicative
of varicocele, temperature at pampiniform plexus ā„34 CĀ°, temperature difference between left and
right pampiniform plexus ā„0.5 CĀ°, enhancement of image during Valsalva maneuver, and temperature
at pampiniform plexus ā„ temperature at ipsilateral thigh. Three or more positive signs are indicative of
varicocele. The aim of this report is to present the use of digital thermography as a diagnostic method
to evaluate the outcome of varicocele repair. We present a case of a student diagnosed with varicocele
grade III, and assessed preoperatively and followed up postoperatively by scrotal thermography. According
to thermographic indicators, our patient was positive for varicocele diagnosis before surgical
treatment. Three months after varicocele repair, the patient did not show positive thermographic indicators
of varicocele while physical examination and color Doppler ultrasound were equivocal. This case
report suggests that infrared digital thermography of scrotum could be very valuable for monitoring
patients in the period after surgery for varicocele, however, it should be confirmed in a larger number
of patients.Termografija skrotuma je metoda dijagnostike varikokele. Postoji pet termografskih dijagnostiÄkih kriterija za dijagnozu
varikokele: termografski prikaz karakteristiÄan za varikokelu, temperatura pampiniformnog pleksusa ā„34 CĀ°, razlika temperature
izmeÄu lijevog i desnog pampiniformnog pleksusa ā„0,5 CĀ°, indikativna promjena slike prilikom Valsalvina manevra
i temperatura pampiniformnog pleksusa koja je ā„ temperaturi ipsilateralne natkoljenice. Tri ili viÅ”e pozitivnih znakova predstavlja
pozitivan nalaz u sluÄaju dijagnostike varikokele. Cilj ovoga rada je prikazati primjenu termografije skrotuma kao
dijagnostiÄke metode u procjeni ishoda operacije varikokele. Prikazat Äemo sluÄaj studenta koji je imao dijagnozu varikokele
III. stupnja te je prijeoperacijski dijagnosticiran, a poslijeoperacijski praÄen termografijom skrotuma. Prema termografskim
kriterijima ovaj bolesnik je prijeoperacijski imao varikokelu. Tri mjeseca nakon operacije bolesnik nije imao pozitivne termografske
znakove za varikokelu, meÄutim, kliniÄki pregled i obojeni doppler nisu bilo tako uvjerljivi. Ovaj prikaz sluÄaja
pokazuje moguÄnost primjene termografije skrotuma u praÄenju bolesnika nakon operacije varikokele, no ovo svakako treba
potvrditi na veÄem broju ispitanika