23 research outputs found
Rational Management of Diabetes type 2
Å eÄerna bolest tipa 2 vrlo je Äesta bolest
kojoj prevalencija progresivno raste s dobi. Uz patofiziologiju
i klasifikaciju u Älanku se razraÄuje konvencionalni i
intenzivni pristup lijeÄenju. 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 āfountain of youthā continues today.JoÅ” od 19. stoljeÄa bilo je sporadiÄnih pokuÅ”aja da se promjene u starenju pripiÅ”u nekom endokrinom deficitu, kao i nastojanja da se utjeÄe na te promjene razliÄitim nadomjesnim terapijama. Ta potraga za hormonskim āizvorom mladostiā traje do danaÅ”njih dana
Metabolic Insulin Resistance and Purine Metabolism
MetaboliÄki sindrom ili sindrom X nekoliko je
meÄusobno povezanih abnormalnosti koje poveÄavaju rizik
od nastanka kardiovaskularnih i cerebrovaskularnih bolesti.
To su dijabetes, hipertenzija, dislipidemija, hiperuricemija,
debljina, odnosno bolesti u kojih se na poÄetku patofi zioloÅ”kog
slijeda nalazi inzulinska rezistencija.
S kliniÄkoga glediÅ”ta, hiperuricemija treba upozoriti kliniÄara
na poveÄani rizik od vaskularnih bolesti. Uloga uriÄne
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 Äimbenika u kliniÄkoj evaluaciji
i gradiranju fenomena metaboliÄkog 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 guÅ”teraÄe s izraženim karcinoidnim sindromom: prikaz sluÄaja
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 najÄeÅ”Äi tip neuroendokrinih tumora, primarno smjeÅ”tenih u tankom crijevu i apendiksu. Mali broj ovih tumora, nakon Å”to metastazira u jetru, prezentira se simptomima karcinoidnog sindroma (rumenjaÄa, proljevi). Prikazan je karcinoid guÅ”teraÄe, neuobiÄajene lokalizacije za ovu vrst tumora. Bolesnik u dobi od 54 godine upuaen je u kliniku zbog gubitka na težini, rumenjaÄe i proljeva. Vrijednosti 5-HIAA i CA 19-9 bile su izrazito poviÅ”ene. UltrazvuÄno i magnetskom rezonancom prikazan je tumor predpapilarnog podruÄja te uveÄana jetra prožeta viÅ”estrukim sekundarizmima, a patohistoloÅ”ki nalaz govorio je u prilog neuroendokrinog tumora tipa karcinoida. S obzirom na proÅ”irenost procesa odustalo se od kirurÅ”kog lijeÄenja te je zapoÄeta terapija Sandostatinom uza znaÄajno kliniÄko poboljÅ”anje, no bez uÄinka na 5-HIAA
Utjecaj novih saznanja i stavova o bolestima na terapijsko odluÄivanje lijeÄnika
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 lijeÄnika prema alkoholiÄarima i bolesnicima s alkoholnom boleÅ”Äu jetre, te njihovo znanje o patofiziologiji i lijeÄenju 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 lijeÄenju. Istraživanje je provedeno u Klinikama za unutarnje bolesti KliniÄke bolnice "Sestre milosrdnice" i KliniÄkog bolniÄkog centra "Zagreb", Hrvatska (n=40) te Emory School of Medicine, Atlanta, Sjedinjene AmeriÄke Države (n=30). U skupini lijeÄnika iz Zagreba bilo je statistiÄki znaÄajno viÅ”e internista (p=0,025) i sa znaÄajno dužim specijalistiÄkim stažem (p=0,006). ZnaÄajna je bila razlika meÄu skupinama u odgovorima na pitanja Å”to je: alkoholizam (p=0,006), toÄna patofizioloÅ”ka 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), bioloÅ”ki uÄinak atrijskog natriuretiÄnog peptida (p<0,001), terapijski uÄinak spironolaktona (p=0,005) i paracenteza (p=0,009), kao i u uÄestalosti toÄnih 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 lijeÄnika iz Atlante. StatistiÄki znaÄajno viÅ”e lijeÄnica iz Zagreba je znalo stoljeÄe roÄenja Leonarda da Vincija (p=0,018). Zabilježili smo negativan stav prema alkoholiÄarima i bolesnicima s alkoholnom cirozom jetre u skupini lijeÄnika iz Zagreba, te nedostatak znanja o patofizioloÅ”kim mehanizmima nastanka ascitesa i novim protokolima njegovog lijeÄenja u objema skupinama. LijeÄnikov stav i znanje imaju utjecaja na terapijsko odluÄivanje. SkraÄenje vremena potrebnog za prihvaÄanje novih spoznaja o uÄinkovitosti novih ili etabliranih protokola lijeÄenja s izmjenama u indikacijama ili naÄinu i vremenu primjene od strane praktiÄara je neophodno i proporcionalno je sa znanjem