64 research outputs found
KroniÄni dugotrajni nelijeÄeni giht s istodobnom dilatacijskom kardiomiopatijom i iznimno opsežnom anasarkom
Gout is the most common type of inflammatory arthritis in man caused by deposition of urate crystals into the joints as the result of elevated serum urate levels. A case of a 59-year-old patient with untreated, long-lasting gout and clinical manifestation of decompensated global dilated cardiomyopathy is presented. Examination revealed generalized pitting edema extending from both lower extremities to the sacrum, abdominal, and thoracic wall, with scrotal swelling and upper extremity involvement, an exceptionally vast generalized edema, i.e. anasarca. Proximal and distal interphalangeal joints of the hands and feet were swollen and deformed, with marked yellow tophi nodules. Laboratory studies revealed high serum uric acid concentration (546 Ī¼mol/L), decreased creatinine clearance (0.8 mL/s) and albumin concentration (27.4 g/L), as well as increased total urine protein mass (0.35 g/24 h). X-rays of the affected feet and fists showed punched-out lesions of the subchondral bone with overhanging bony margins in the first metatarsophalangeal, proximal, and distal interphalangeal joints of both hands. The extreme clinical presentation resolved upon intravenous administration of diuretics and pleurocentesis, followed by oral medications including furosemide, angiotensin-converting enzyme inhibitor, spironolactone and digoxin. Since serum urate level has been identified as an independent risk factor for the development of ischemic heart and chronic kidney disease, regulation of urate concentration is necessary, especially in patients diagnosed with gout.Giht je najÄeÅ”Äi tip upalnog artritisa, a uzrokovan je nakupljanjem kristala urata u zglobovima kao rezultat poviÅ”ene razine urata u serumu. Prikazan je sluÄaj 59-godiÅ”njeg bolesnika s nelijeÄenim uriÄnim artritisom i kliniÄkom manifestacijom globalno dekompenzirane dilatacijske kardiomiopatije. KliniÄkim pregledom dominirala je anasarka, tj. opsežan generalizirani tjestasti edem oba gornja i donja ekstremiteta, skrotalni otok, edem trbuÅ”ne i prsne stijenke. Proksimalni i distalni interfalangealni zglobovi Å”aka i stopala bili su oteÄeni i deformirani, uz vidljive žute ÄvoriÄaste tofe. Laboratorijski testovi pokazali su visoku koncentraciju mokraÄne kiseline u serumu (546 Ī¼mol/L), smanjeni klirens kreatinina (0,8 mL/s) i koncentraciju albumina (27,4 g/L), te poviÅ”enu ukupnu masu bjelanÄevina u mokraÄi (0,35 g/24 h). Rendgenske snimke zahvaÄenih stopala i Å”aka pokazale su destrukcije i rubne uzure s uzdignuÄem korteksa u prvom metatarzofalangealnom, proksimalnom i distalnom interfalangealnom zglobu obiju Å”aka. Ova ekstremna kliniÄka slika rijeÅ”ena je intravenskom primjenom diuretika i pleurocentezom, nakon Äega je slijedila oralna terapija ukljuÄujuÄi furosemid, inhibitor enzima za konverziju angiotenzina, spironolakton i digoksin. Kako su serumske razine urata utvrÄene kao neovisan Äimbenik rizika za razvoj ishemijske srÄane i kroniÄne bubrežne bolesti, regulacija koncentracije urata je neophodna, naroÄito kod bolesnika s dijagnosticiranim gihtom
S kakvim je zdravstvenim rizikom udružena amenoreja?
Amenorrhea is one of the most common symptoms in the womanās health pathology. It can be caused by anatomical defects of the outflow tract (uterus, cervix, vagina), thus being in the gynecologistās domain, or can be observed in gonadal dysgenesis (Turnerās syndrome), hypopituitarism (Sheehanās syndrome), prolactin-secreting pituitary tumors, Cushingās syndrome, hyperthyroidism, stress, anorexia nervosa, polycystic ovaries, and in women upon discontinuation of oral contraceptives, especially if they have a history of prior menstrual irregularities. Endocrine abnormalities may also be due to changes in target tissue responses to hormones. These disorders can occur by a variety of mechanisms. Endocrine glands may be injured or destroyed by neoplasia, infections, hemorrhage, autoimmune disorders, and many other causes. Menopause, pregnancy and lactation are the most common causes of ammenorrhea. Hypothalamic lesions resulting in impaired secretion of releasing hormones may manifest themselves by pituitary dysfunction, which in turn leads to functional abnormalities of its various target organs. Extraglandular disorders can result in hormone deficiency and become manifest with amenorrhea as one of the symptoms. Assessment of the patientās endocrine status relies on the findings from the history, physical examination and laboratory testing. The latter can include measurement of hormone levels of their metabolites in plasma or urine either in basal state or in response to provocative testing. For endocrine deficiency syndromes, hormones are generally administered to counteract the deficiency. In hormone excess syndromes, a variety of approaches have been used. Hyperfunctioning tumors are removed when possible, and sometimes hyperplastic glands are extirpated. In other cases, drugs are given to block hormone production. Menopause related osteoporosis is the leading health problem associated with amenorrhea and should be treated as early as possible, i.e. from the beginning of the period of menses disappearance.Amenoreja je jedan od najÄeÅ”Äih simptoma u ženskoj patologiji. Ona može biti uzrokovana anatomskim nedostacima izlaznoga trakta (maternica, uÅ”Äe maternice, rodnica) pa spada u djelokrug ginekologa, no može se zapaziti kod bolesti nedostatka gonada (npr. Turnerov sindrom), hipopituitarizma (npr. Sheehanov sindrom), u bolesnika s tumorima hipofize koji luÄe prolaktin, kod Cushingova sindroma, hipertiroze, stresa, anoreksije nervosa, policistiÄnih jajnika, te nakon prestanka uzimanja oralnih kontraceptiva, poglavito u žena s prethodnim menstrualnim nepravilnostima u anamnezi. Endokrine abnormalnosti mogu isto tako biti uzrokovane promjenama u odgovoru ciljnih tkiva na hormone. RazliÄiti mehanizmi mogu biti ukljuÄeni u nastanak ovih bolesti. Endokrine žlijezde mogu biti oÅ”teÄene ili uniÅ”tene neoplazijom, infekcijama, krvarenjem, autoimunim bolestima, te mnogim drugim uzrocima. NajÄeÅ”Äi uzroci amenoreje su menopauza, trudnoÄa i dojenje. OÅ”teÄenja hipotalamusa koja dovode do poremeÄenog luÄenja hormona za otpuÅ”tanje mogu se oÄitovati disfunkcijom hipofize, Å”to opet rezultira funkcionalnim abnormalnostima razliÄitih ciljnih organa. PoremeÄaji izvan te žlijezde mogu dovesti do pomanjkanja hormona i postati oÄitima, uz amenoreju kao jedan od simptoma. Procjena endokrinog statusa bolesnice temelji se na nalazima iz anamneze, fizikalnog pregleda i laboratorijskih pretraga. Laboratorijski testovi mogu ukljuÄivati mjerenje razina hormona ili njihovih metabolita u plazmi ili mokraÄi u bazalnom stanju ili u odgovoru na provokativno testiranje. Kod sindroma endokrine deficijencije hormoni se uglavnom daju kako bi se ispravila ta deficijencija. Kod sindroma s viÅ”kom hormona primjenjuju se razliÄiti pristupi. Tumori koji pokazuju hiperfunkciju se odstranjuju kadgod je to moguÄe, a ponekad se uklanjanju i hiperplastiÄne žlijezde. U drugim pak sluÄajevima daju se lijekovi za suzbijanje stvaranja hormona. Osteoporoza povezana s menopauzom vodeÄi je zdravstveni problem povezan s amenorejom i treba ju Å”to ranije lijeÄiti, tj. od poÄetka razdoblja prestanka menstruacije
S kakvim je zdravstvenim rizikom udružena amenoreja?
Amenorrhea is one of the most common symptoms in the womanās health pathology. It can be caused by anatomical defects of the outflow tract (uterus, cervix, vagina), thus being in the gynecologistās domain, or can be observed in gonadal dysgenesis (Turnerās syndrome), hypopituitarism (Sheehanās syndrome), prolactin-secreting pituitary tumors, Cushingās syndrome, hyperthyroidism, stress, anorexia nervosa, polycystic ovaries, and in women upon discontinuation of oral contraceptives, especially if they have a history of prior menstrual irregularities. Endocrine abnormalities may also be due to changes in target tissue responses to hormones. These disorders can occur by a variety of mechanisms. Endocrine glands may be injured or destroyed by neoplasia, infections, hemorrhage, autoimmune disorders, and many other causes. Menopause, pregnancy and lactation are the most common causes of ammenorrhea. Hypothalamic lesions resulting in impaired secretion of releasing hormones may manifest themselves by pituitary dysfunction, which in turn leads to functional abnormalities of its various target organs. Extraglandular disorders can result in hormone deficiency and become manifest with amenorrhea as one of the symptoms. Assessment of the patientās endocrine status relies on the findings from the history, physical examination and laboratory testing. The latter can include measurement of hormone levels of their metabolites in plasma or urine either in basal state or in response to provocative testing. For endocrine deficiency syndromes, hormones are generally administered to counteract the deficiency. In hormone excess syndromes, a variety of approaches have been used. Hyperfunctioning tumors are removed when possible, and sometimes hyperplastic glands are extirpated. In other cases, drugs are given to block hormone production. Menopause related osteoporosis is the leading health problem associated with amenorrhea and should be treated as early as possible, i.e. from the beginning of the period of menses disappearance.Amenoreja je jedan od najÄeÅ”Äih simptoma u ženskoj patologiji. Ona može biti uzrokovana anatomskim nedostacima izlaznoga trakta (maternica, uÅ”Äe maternice, rodnica) pa spada u djelokrug ginekologa, no može se zapaziti kod bolesti nedostatka gonada (npr. Turnerov sindrom), hipopituitarizma (npr. Sheehanov sindrom), u bolesnika s tumorima hipofize koji luÄe prolaktin, kod Cushingova sindroma, hipertiroze, stresa, anoreksije nervosa, policistiÄnih jajnika, te nakon prestanka uzimanja oralnih kontraceptiva, poglavito u žena s prethodnim menstrualnim nepravilnostima u anamnezi. Endokrine abnormalnosti mogu isto tako biti uzrokovane promjenama u odgovoru ciljnih tkiva na hormone. RazliÄiti mehanizmi mogu biti ukljuÄeni u nastanak ovih bolesti. Endokrine žlijezde mogu biti oÅ”teÄene ili uniÅ”tene neoplazijom, infekcijama, krvarenjem, autoimunim bolestima, te mnogim drugim uzrocima. NajÄeÅ”Äi uzroci amenoreje su menopauza, trudnoÄa i dojenje. OÅ”teÄenja hipotalamusa koja dovode do poremeÄenog luÄenja hormona za otpuÅ”tanje mogu se oÄitovati disfunkcijom hipofize, Å”to opet rezultira funkcionalnim abnormalnostima razliÄitih ciljnih organa. PoremeÄaji izvan te žlijezde mogu dovesti do pomanjkanja hormona i postati oÄitima, uz amenoreju kao jedan od simptoma. Procjena endokrinog statusa bolesnice temelji se na nalazima iz anamneze, fizikalnog pregleda i laboratorijskih pretraga. Laboratorijski testovi mogu ukljuÄivati mjerenje razina hormona ili njihovih metabolita u plazmi ili mokraÄi u bazalnom stanju ili u odgovoru na provokativno testiranje. Kod sindroma endokrine deficijencije hormoni se uglavnom daju kako bi se ispravila ta deficijencija. Kod sindroma s viÅ”kom hormona primjenjuju se razliÄiti pristupi. Tumori koji pokazuju hiperfunkciju se odstranjuju kadgod je to moguÄe, a ponekad se uklanjanju i hiperplastiÄne žlijezde. U drugim pak sluÄajevima daju se lijekovi za suzbijanje stvaranja hormona. Osteoporoza povezana s menopauzom vodeÄi je zdravstveni problem povezan s amenorejom i treba ju Å”to ranije lijeÄiti, tj. od poÄetka razdoblja prestanka menstruacije
Može li dugotrajna velika depresija izazvati osteoporozu?
A marked clinical, physiologic, and biochemical connection between osteoporosis and major depressive disorder (MDD) is described. There are numerous states and diseases associated with osteoporosis. The aim of the study was to assess the presumed association between hypercortisolism and osteoporosis. Some recent studies provided evidence for association between previous history of MDD and marked osteoporosis. In MDD, there are two well documented biochemical abnormalities, hypercortisolism and its resistance to dexamethasone suppression. The present study included 31 MDD patients (19 male and 12 female), mean age 37Ā±1.3, age range 29-41 years, and 17 healthy male volunteers mean age 39Ā±1.6, age range 34-45 years. The levels of free cortisol in 24-h urine, serum cortisol at 8 a.m. and 5 p.m., and cortisol in dexamethasone suppression test as well as bone mineral density were measured in all study subjects. The results obtained were analyzed by use of Spearman\u27s nonparametric rank correlation, rho=-0.805, with a statistical significance level of p<0.01 (2-tailed). Study results suggested that patients with a long-term history of depression may develop a severe form of osteoporosis. Also, a severe form of osteoporosis has been known to develop in patients with untreated Cushing\u27s syndrome.Opisana je kliniÄka, fizioloÅ”ka i biokemijska povezanost osteoporoze i velike depresije. U oba stanja dolazi do hiperaktivnostiosi HPA, sustava LC/NE, te poviÅ”enog luÄenja CRH, kortizola i katekolamina. Mnoga stanja i bolesti povezane su s osteoporozom, ukljuÄujuÄi hiperkorticizam. Novija istraživanja povezuju raniju povijest velike depresije s osteoporozom. U velikoj depresiji zabilježene su dvije biokemijske abnormalnosti: hiperkorticizam i rezistencija na supresiju deksametazonom. U naÅ”e je istraživanje bio ukljuÄen 31 bolesnik s velikom depresijom (19 muÅ”karaca i 12 žena) prosjeÄne dobi od 37Ā±1,3 godine, te 17 muÅ”kih dobrovoljaca u dobi od 34 do 45 godina, prosjeÄne dobi od 39Ā±1,6 godina. U svih je bolesnika odreÄivana razina kortizola u 24-satnoj mokraÄi, serumski kortizol, kortizol u testu supresije deksametazonom, a gustoÄa kostiju je odreÄivan adenzitometrijski. Bila je to skupina mlaÄih muÅ”karaca i žena s održanim menstruacijskim ciklusom, u poÄetku bez osteoporoze, ali godinama pod antidepresivnom terapijom. Analiza rezultata pokazala je poviÅ”ene vrijednosti kortizola, te pojavu osteoporoze razvoj koje je bio posljedica poviÅ”ene razine kortizola. U analizi rezultata primijenjena je neparametrijska korelacija rangova, pri Äem je Spearmanov rho bio -0,805 uz statistiku znaÄajnost od p<0,01. Na temelju rezultata ispitivanja zakljuÄeno je da bolesnici lijeÄeni zbog depresije imaju poviÅ”enu razinu kortizola u 24-satnoj mokraÄi. Bolesnici koji su duže bolovali od depresije imali su jaÄe izraženu osteoporozu. Kortizol vjerojatno ima znaÄajnu ulogu u nastanku osteoporoze u bolesnika s depresijom, a poznato je da se u bolesnika s nelijeÄenim Cushingovim sindromom takoÄer razvija jak oblik osteoporoze
LijeÄenje polipa žuÄnoga mjehura: prijedlog optimalne strategije
Polypoid lesions of the gallbladder can be divided into benign and malignant lesions. Benign polypoid lesions of the gallbladder are divided into tumors and pseudotumors. Pseudotumors make up the majority of polypoid lesions of the gallbladder. They can occur in the form of polyps, hyperplasia or other miscellaneous lesions. Adenomas are the most common benign neoplasms of the gallbladder. Ultrasound has been demonstrated to be significantly better in detecting polypoid lesions of the gallbladder as compared with computed tomography and cholecystography. Recommendations for an optimal strategy in the management of gallbladder polyps are presented. Generally, no treatment is required in a young patient with very small gallbladder polyps, who is completely free from symptoms. In patients with unequivocal recurrent biliary colic, elective cholecystotomy is warranted, especially in case of coexistence of stones and polyps. Cholecystectomy is also indicated in patients with gallbladder polyps greater than 10 mm, irrespective of symptomatology. In patients with gallbladder polypoid lesions smaller than 10 mm, cholecystectomy is only indicated if complicating factors are present, e.g., age Ā³ 50 and coexistence of gallstones. If a gallbladder polyp is smaller than 10 mm and if complicating factors are absent, the āwatch-and-waitā strategy seems to be recommendable.Polipoidne lezije žuÄnoga mjehura mogu se podijeliti u benigne i maligne. Benigne polipoidne lezije dijele se na prave tumore i pseudotumore. Pseudotumori Äine veÄinu polipoidnih lezija žuÄnoga mjehura, a mogu se oÄitovati kao polipi, hiperplazija ili druge razliÄite lezije. Adenomi predstavljaju najÄeÅ”Äe benigne neoplazme žuÄnoga mjehura. Pokazalo se da je ultrazvuk znaÄajno bolji u otkrivanju polipoidnih lezija žuÄnoga mjehura u usporedbi s kompjutoriziranom tomografijom i kolecistografijom. U ovom su radu prikazane preporuke za optimalnu strategiju praÄenja i obrade polipa žuÄnoga mjehura. OpÄenito, u mladog bolesnika s polipima žuÄnoga mjehura manjim od 10 mm i bez simptoma nije potrebna nikakva terapija. U bolesnika s jasnim kolikama elektivna kolecistektomija je opravdana, poglavito ako su uz polipe prisutni i žuÄni kamenci. Kolecistektomija je takoÄer indicirana u bolesnika s polipima veÄim od 10 mm, bez obzira na simptomatologiju. U bolesnika s polipima manjim od 10 mm kolecistektomija je indicirana samo ako se radi o bolesnicima starijim od 50 godina i/ili ako su istodobno prisutni i žuÄni kamenci. Kad su polipi žuÄnoga mjehura manji od 10 mm i ako se radi o bolesnicima mlaÄim od 50 godina u kojih nije moguÄe dokazati žuÄne kamence, preporuÄujemo strategiju āpratiti i Äekatiā
Hrvatsko-brazilski projekt rak dojke i kliniÄko istraživanje kreativnih i art/suportivno-ekspresivnih oblika (psiho)terapije
This paper shows an innovative concept of a Croatian-Brazilian project in the field of psychosocial oncology and sophrology. Within this context, the paper presents the basic outline of a research protocol for conducting a transcultural study relating to the implementation of supportive-expressive arts psychotherapies providing complementary approaches to a complex treatment and rehabilitation program for breast cancer patients. Some forms of past cooperation between the Croatian and Brazilian universities, healthcare institutions and professional associations are presented with reference to the major topics discussed at the Latin American Congress of Art Therapy. This Croatian-Brazilian cooperation has been envisaged in the outline of a research project on āSupportive Therapies and Life Potential Developmentsā supported by the Croatian Ministry of Science.U ovom radu prikazan je inovativni koncept hrvatsko-brazilskog projekta u podruÄju psihosocijalne onkologije i sofrologije. U tom okviru prikazne su osnovne crte plana znanstvenog istraživanja za provoÄenje transkulturne studije koja se odnosi na primjenu art/suportivno-ekspresivnih oblika psihoterapije kao komplementarnih pristupa u kompleksnom lijeÄenju i rehabilitaciji bolesnica s rakom dojke. U vezi s tim neki oblici dosadaÅ”nje suradnje izmeÄu hrvatskih i brazilskih sveuÄiliÅ”nih i kliniÄkih institucija i profesionalnih udruga, prikazani su s osvrtom na sadržaj latinsko-ameriÄkog kongresa o art terapijama. Hrvatsko-brazilska suradnja predviÄena je u sadržaju znanstvenog projekta āSuportivne terapije i razvoj životnih potencijalaā koji je podržalo Ministarstvo znanosti Republike Hrvatsk
Prikaz bolesnika s ektopiÄnom sekrecijom ACTH i znacima Cushingova sindroma
Ectopic ACTH secretion was the first paraneoplastic endocrine syndrome described in the literature. The most common tumors associated with ectopic ACTH production are small-cell lung cancer and atypical carcinoids. High cortisol levels have also been described in patients with adenocarcinoma and large-cell carcinoma of the lung, other carcinoid tumors, thymoma, neural crest tumors, medullary carcinoma of the thyroid, and bronchial adenomas. Patients rarely live long enough for frank Cushingās syndrome to develop. A 30-year-old male is described, who was admitted to endocrinology ward for clinical features of Cushingās syndrome. Outpatient examination showed high levels of plasma cortisol on several occasions, without suppression of night dexamethasone test. Laboratory tests performed during his hospital stay showed an increased level of serum cortisol without suppression of night dexamethasone test, increased level of ACTH, and decreased testosterone level, increased 17 OHCS in urine. CT scan of adrenal and pituitary glands, and chest x-ray were normal. The patient was discharged with an appointment made for surgical exploration of the pituitary gland. Transnasal selective partial hypophysectomy was performed, however, excisional biopsy showed no microadenoma while the symptoms persisted postoperatively. The patient received TCT hypophysis in a maximal dose, and elevated ACTH level was found to persist after 37 days of treatment. One year later, the patient was readmitted for persistent cushinoid appearance. After complete investigations for ectopic ACTH secreting tumor, chest x-ray showed an infraclavicular, circular, sharply demarcated inhomogeneous lesion of the left lung, 2x3 cm in size. Three months later, lobectomy was performed and pathohistologic examination pointed to a carcinoid (argentaffinoma). During hospitalization, the symptoms of Cushingās syndrome regressed. In conclusion, CRH test which usually distinguishes between hyperadrenocorticism associated with ectopic ACTH secretion and hypersecreting adrenal tumors is sometimes misleading because of the large overlap in normal and abnormal responses. In this case, chest or abdominal CT scan or MRI should be performed, because these are the most common sites of ectopic ACTH secreting tumors.Prvi paraneoplastiÄni endokrini sindrom opisan u literaturi bila je ektopiÄna sekrecija ACTH. NajÄeÅ”Äi tumori udruženi s ektopiÄnom sekrecijom ACTH su mikrocelularni karcinom pluÄa i atipiÄni karcinoidi. Visoke razine kortizola opisane su i u bolesnika s adenokarcinomom i karcinomom velikih stanica pluÄa, karcinoidima, timomom, tumorima neuralnog grebena, medularnim karcinomom Å”titnjaÄe i bronhalnim adenomom. Bolesnici rijetko žive dovoljno dugo da razviju manifestan Cushingov sindrom. Opisan je sluÄaj 30-godiÅ”njeg muÅ”karca koji je primljen na odjel s kliniÄkim znacima Cushingova sindroma. Ambulantno ispitivanje pokazalo je u viÅ”e navrata visoke razine kortizola koji se nije snižavao u kratkom deksametazonskom testu. Tijekom boravka u bolnici je uz veÄ navedeno uoÄena visoka razina ACTH, sniženi testosteron i poviÅ”en 17 OHCS u mokraÄi. CT nadbubrežnih žlijezda i Rtg snimka prsnog koÅ”a bili su uredni. Bolesnik je otpuÅ”ten uz dogovor za kirurÅ”ku eksploraciju hipofize, te je uÄinjena transnazalna djelomiÄna hipofizektomija. Ekscizijska biopsija nije pokazala znakove tumora, a kliniÄki znaci Cushingova sindroma ustrajali su nakon operacije. Bolesnik je podvrgnut radioterapiji hipofize u maksimalnoj dozi, meÄutim, vrijednosti ACTH su joÅ” uvijek bile poviÅ”ene. Nakon godinu dana bolesnik je ponovno primljen na odjel zbog ustrajnih znakova Cushingova sindroma. Nakon potpune obrade u smislu traženja ektopiÄne sekrecije ACTH, snimka prsnoga koÅ”a pokazala je infraklavikularno oÅ”tro ograniÄenu, nehomogenu sjenu u pluÄima, veliÄine 2x3 cm. Tri mjeseca kasnije uÄinjena je lobektomija, a patohistoloÅ”ki nalaz je ukazao na karcinoid (argentafinom). Tijekom hospitalizacije simptomi Cushingova sindroma su se povukli. U zakljuÄku, CRH test koji obiÄno razlikuje hiperadrenokorticizam udružen s ektopiÄnom sekrecijom ACTH i hipersekreciju iz adrenalnih tumora, ponekad je neprikladan zbog znaÄajnog preklapanja u normalnom i abnormalnom odgovoru. U tom sluÄaju, nužan je detaljan pregled prsnoga koÅ”a i trbuha, buduÄi da su to najÄeÅ”Äa sijela tumora koji ektopiÄno izluÄuju ACTH
Hrvatsko-brazilski projekt rak dojke i kliniÄko istraživanje kreativnih i art/suportivno-ekspresivnih oblika (psiho)terapije
This paper shows an innovative concept of a Croatian-Brazilian project in the field of psychosocial oncology and sophrology. Within this context, the paper presents the basic outline of a research protocol for conducting a transcultural study relating to the implementation of supportive-expressive arts psychotherapies providing complementary approaches to a complex treatment and rehabilitation program for breast cancer patients. Some forms of past cooperation between the Croatian and Brazilian universities, healthcare institutions and professional associations are presented with reference to the major topics discussed at the Latin American Congress of Art Therapy. This Croatian-Brazilian cooperation has been envisaged in the outline of a research project on āSupportive Therapies and Life Potential Developmentsā supported by the Croatian Ministry of Science.U ovom radu prikazan je inovativni koncept hrvatsko-brazilskog projekta u podruÄju psihosocijalne onkologije i sofrologije. U tom okviru prikazne su osnovne crte plana znanstvenog istraživanja za provoÄenje transkulturne studije koja se odnosi na primjenu art/suportivno-ekspresivnih oblika psihoterapije kao komplementarnih pristupa u kompleksnom lijeÄenju i rehabilitaciji bolesnica s rakom dojke. U vezi s tim neki oblici dosadaÅ”nje suradnje izmeÄu hrvatskih i brazilskih sveuÄiliÅ”nih i kliniÄkih institucija i profesionalnih udruga, prikazani su s osvrtom na sadržaj latinsko-ameriÄkog kongresa o art terapijama. Hrvatsko-brazilska suradnja predviÄena je u sadržaju znanstvenog projekta āSuportivne terapije i razvoj životnih potencijalaā koji je podržalo Ministarstvo znanosti Republike Hrvatsk
Utjecaj oktreotida na luÄenje hormona rasta u bolesnika s akromegalijom
A majority of growth hormone secreting pituitary adenomas respond well to somatostatin and somatostatin analogues. The acute action of octreotide, a synthetic somatostatin analogue, on growth hormone secretion was assessed in 42 patients with clinically and laboratory verified acromegaly. Octreotide was administered subcutaneously in a dose of 50 mg. Blood sampling was performed at 1-hour intervals during 6 hours of testing. The mean basal values of growth hormone (cĀ±SE) was 26.3Ā±4.5 ng/ml (range 6.1-66.6 ng/ml), and of IGF-I 2940Ā±171.7 IU/l (range 2350-4856 IU/l). Reduction in growth hormone values below 5 ng/ml was recorded in 31 (73.8%), suppression by more than 50% in 5 (11.9%) and by more than 45% in 3 (7.1%) patients. Maximal suppression was noticed in the first two hours of testing. In 3 (7.1%) patients, resistance to octreotide with no change in growth hormone values was observed. In conclusion, octreotide reduces growth hormone values in most acromegalic patients. A small proportion of acromegalic patients do not respond well to octreotide, probably due to the lack of somatostatin receptors on tumor cells. We consider the acute octreotide test as a very useful tool in triage of acromegalic patients eligible for medicamentous treatment.VeÄina adenoma hipofize koji luÄe hormon rasta zadrže osjetljivost na somatostatin i njegove analoge. Ispitivano je akutno djelovanje oktreotida, sintetskog oktapeptidnog analoga somatostatina, na razinu hormona rasta u 42 bolesnika s kliniÄki i laboratorijski potvrÄenom akromegalijom. Oktreotid je primijenjen supkutano u dozi od 50 mg. Uzorci krvi za odreÄivanje hormona rasta uzimani su svakog sata u razdoblju od Å”est sati. ProsjeÄna bazalna vrijednost hormona rasta bila je 26,3Ā±4,5 cĀ±SE) ng/ml (raspon 6,1-66,6 ng/ml), a IGF-I 2940,2Ā±171,7 IJ/l (raspon 2350-4856 IJ/l). Nakon primjene oktreotida razina hormona rasta u serumu snizila se na normalne vrijednosti (<5 ng/ml) u 31 (73,8%) bolesnika, u 5 (11,9%) bolesnika nastupilo je sniženje za viÅ”e od 50%, a u 3 (7,1%) za viÅ”e od 45%. Maksimalno je sniženje u ovih bolesnika uslijedilo jedan do dva sata nakon poÄetka testa. Troje (7,1%) bolesnika pokazalo je rezistenciju na oktreotid. Njihove vrijednosti hormona rasta ostale su gotovo jednake onima u bazalnim uvjetima. ZakljuÄeno je da oktreotid normalizira razinu hormona rasta u veÄine akromegaliÄnih bolesnika, meÄutim, u nekih se ne postiže zadovoljavajuÄi odgovor, vjerojatno zbog malog broja somatostatinskih receptora na membrani tumorskih stanica. Smatramo da je akutni test s oktreotidom koristan u odabiru akromegaliÄnih bolesnika za konzervativno lijeÄenje analozima somatostatina
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