Background. In the past thirty years, there has been a significant rise of public and private health institutions’ interest in the prediction and management of medical risks. The need of risk ...management is a direct consequence of the growing number of legal actions against medical malpractice. The concept of risk management involves three basic processes: risk identification, risk analysis, and risk management. Risk includes an evaluation of vulnerability and management of events that could potentially endanger the operation of a health institution, comprising a balance between the consequential costs of medical malpractice and the costs of risk reduction (anticipation). Thus the potential financial consequences of risk exposure are crucial in the formation of diagnostic and treatment protocols, whereas improvement of the quality of medical care as well as patient protection are the primary aims of risk management. Conclusions. Postmenopausal health care is not an exempt when considering possible erorrs in medication or medical process per se. On the orther hand menopausal medicine is not only hormonal replacement therapy but also bunch of complementary and alternative specialities involved in the healing process where error could be easily achieved.
Highlights • We examined the effect off nitroglycerin, norepinephrine and aminophylline on IPAVA. • All drugs revealed well known hemodynamic effects. • None of the drugs were not found to promote ...intrapulmonary arteriovenous opening. • Application of these drugs does not open the pathway for systemic embolization of vital organs.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
New Findings
What is the central question of this study?
Does a patent foramen ovale contribute to resting arterial hypoxaemia, defined as arterial oxygen saturation <95%, in subjects with chronic ...heart failure with or without pulmonary arterial hypertension?
What is the main finding and its importance?
The presence of a patent foramen ovale contributed to resting arterial hypoxaemia only in subjects with chronic heart failure with pulmonary arterial hypertension. These data suggest that the presence of a patent foramen ovale should be considered in chronic heart failure patients with arterial hypoxaemia and pulmonary hypertension.
The roles of intrapulmonary and intracardiac shunt in contributing to arterial hypoxaemia at rest in subjects with chronic heart failure (CHF) have not been well investigated. We hypothesized that blood flow through intrapulmonary arteriovenous anastomoses (Q̇ IPAVA ) and/or patent foramen ovale (Q̇ PFO ) could potentially contribute to arterial hypoxaemia and, with pulmonary hypertension (PH) secondary to CHF, this contribution may be exacerbated. Fifty‐six subjects with CHF (New York Heart Association Classes I–III), with (+) or without (−) PH defined as peak tricuspid regurgitation velocity ≥2.9 m s−1 (CHF PH+, n = 32) and peak tricuspid regurgitation velocity ≤2.8 m s−1 (CHF PH−, n = 24), underwent arterial blood gas analysis and transthoracic saline contrast echocardiography concomitant with transcranial Doppler to detect Q̇ IPAVA and Q̇ PFO . Seventeen of 56 subjects with CHF (30%) had Q̇ PFO , but only four of 56 subjects with CHF had Q̇ IPAVA (7%), both similar to age‐ and sex‐matched control subjects. Mean arterial oxygen saturation (SaO2) was lower in subjects with Q̇ PFO . Only CHF PH+ subjects with Q̇ PFO had arterial hypoxaemia (mean SaO2 <95%). Bubble scores assessed using transthoracic saline contrast echocardiography were correlated with microembolic signals detected with transcranial Doppler in subjects with Q̇ PFO . Significant Q̇ IPAVA was not present in either CHF PH+ or PH− subjects, suggesting that Q̇ IPAVA is not dependent on increased pulmonary pressure and does not contribute significantly to arterial hypoxaemia in older subjects with CHF. Given that SaO2 was lower in all subjects with CHF who had Q̇ PFO compared with those without Q̇ PFO , a patent foramen ovale should be considered when determining potential causes of arterial hypoxaemia, because Q̇ PFO was present in 30% of these subjects.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Objectives
We determined whether stroke and/or TIA subjects have exercise‐induced blood flow through intrapulmonary arteriovenous anastomoses (QIPAVA) and/or patent foramen ovale (QPFO) and a genetic ...predisposition for ischemic stroke.
Methods
Twenty‐eight stroke and/or TIA subjects (33–63 years old) underwent transthoracic saline contrast echocardiography concomitant with transcranial Doppler to detect QIPAVA and QPFO at rest and during supine exercise with and without breathing 100% O2. We also examined genetic polymorphisms in FV Leiden (G1691A; rs6025), factor II (FII) prothrombin (G20210A; rs1799963), methylene tetrahydfropholate reductase (C677T, rs1801133), and plasminogen‐activator inhibitor‐1 (PAI‐1) (4G/5G; rs1799889) and angiotensin‐converting enzyme (ACE; I/D, rs4646994) in 24/28 subjects.
Results
No subject without PFO had QIPAVA at rest (n=17), but 12/17 did with exercise. All PFO subjects had QPFO at rest (n=11) and 7/11 had either QIPAVA or QPFO with exercise. Breathing 100% O2 during exercise reduced or eliminated left heart contrast in all subjects. Gene analyses revealed that 15/24 patients were either heterozygous or homozygous for methylenetetrahydrofolate reductase gene polymorphism; 4G/4G and 4G/5G genotypes of plasminogen‐activator inhibitor‐1 were present in 7/24 and 13/24 patients, respectively; polymorphisms of ACE D/D genotype were present in 6/24 and I/D in 14/24 patients. Having both I/D and 4G/4G genotypes was more prevalent in PFO+ subjects (P=.03), and there was a trend (P=.06) for PFO− subjects to have a greater D/D genotype prevalence.
Conclusions
Novel genetic predispositions reported here in PFO subjects should be investigated further in larger stroke and/or TIA patient datasets.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Inkontinencija mokraće često je stanje, posebno u žena i bitno utječe na kvalitetu svakodnevnog života.
Pogođeno je čak do 50% žena starije životne dobi. Etiologija inkontinencije mokraće i prolapsa ...zdjeličnih organa nije u cijelosti poznata, ali dovodi se u vezu s vaginalnim porodom. Pri vaginalnom porodu dolazi do poremećaja statike organa male zdjelice uslijed prevelikog rastezanja i oštećenja mišića i fascija. Žene pikničke konstitucije, žene u perimenopauzi, a pogotovo žene u postmenopauzi, zbog pada razine estrogena znatno češće bivaju pogođene. Početkom 90-ih godina 20. stoljeća Integralna teorija Petrosa i Ulmstena označila je prekretnicu u razvoju novih minimalno invazivnih sling metoda. Sve stresne inkontinencije urina (SIU) mogu se liječiti sling metodama koje su danas zlatni standard u liječenju SIU. Nove, minimalno invazivne sling metode većinom su zamijenile klasične operacije za liječenje SIU, bez bojazni od slabije učinkovitosti. Ovim pregledom minimalno invazivnih sling metoda za liječenje SIU želi se usporediti učinkovitost i komplikacije pojedinih inačica navedenih metoda. Obrađene metode uključuju TVT (Tension
free Vaginal Tape) metodu, TOT (Transobturator Tape) metodu, TVT-O (Tension free Vaginal Tape- Obturator), te najnoviju tehniku MiniArc®. TVT metoda podrazumijeva postavljanje mrežaste trake
retropubično pod srednju trećinu uretre. Učinkovitost TVT metode kreće se od 86 do 99%. TOT je transopturatorna metoda, razvijena s ciljem smanjenja intraoperativnih komplikacija povezanih s prodorom
kroz retropubični prostor, koje su moguće kod TVT metode. Nadalje, novija sling tehnika TVT-O u kojoj traka prolazi kroz opturatorni otvor u smjeru od iznutra prema van, svojevrsna je alternativa TOT metodi, jer smanjuje mogućnost komplikacija povezanih s TOT metodom. Najnovija tehnika, MiniArc®, nastavak je razvoja minimalno invazivnih metoda liječenja SIU, ali za jednoznačan zaključak o učinkovitosti i sigurnosti potrebno je više podataka o ovoj metodi. Sve metode podjednako su učinkovite, te bolesnice imaju značajno poboljšanu kvalitetu života nakon zahvata. Sumarno, može se reći da transopturatorni pristup ima manje težih komplikacija nego retropubični.
The PROMO (preference for once monthly bisphosphonate) Study, conducted in seven hospital centres in Croatia between June 2007 and June 2008, was designed to analyse patient preference for weekly and ...monthly bisphosphonates in everyday clinical practice where the significant proportion of patients are not completely satisfied with the current osteoporosis treatment. Eligible participants were women with postmenopausal osteoporosis taking weekly bisphosphonates for the last 6 months. Those who agreed to be enrolled were transferred from weekly to monthly ibandronate for the next 6 months. There was no washout period between the two treatment regimens. At the baseline, patients expressed their satisfaction with the weekly treatment. At the end of the study, all patients were asked to complete the five-question survey specially designed for this study. Study population comprised 258 participants. Among 248 patients who completed the study, 244 (98.4%) declared their preference for one of the regimens or they had no preference. Once-monthly regimen was preferred by 231 patients (94.7%), whereas once-weekly regimen was preferred by five patients (2.0%). Eight patients (3.3%) indicated no preference. Furthermore, 93.0% of patients thought that monthly dosing was more convenient. Compared to weekly regimen, monthly dosing was associated with significantly higher satisfaction with the treatment and with significantly less adverse events. In line with these data, 85.9% of patients stated improved quality of life with monthly ibandronate. In summary, the PROMO Study demonstrated strong patient preference for monthly over weekly dosing which is expected to improve suboptimal adherence to weekly bisphosphonates.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
A prospective, open-labelled, multicentre 6-month study was designed to assess three categories that have high impact on Health-Related Quality of Life (HR-QoL). These categories were: satisfaction, ...preference and drug tolerability in postmenopausal patients with osteoporosis in Croatia, at first treated with weekly oral bisphosphonates, followed by monthly oral ibandronate. Three hundred eighty-five postmenopausal women who were treated with one of the weekly bisphosphonates for at least 6 months were included into the study and after they had signed written informed consent, the therapy was changed to monthly ibandronate. Satisfaction with the treatment was assessed with the Osteoporosis Patient Satisfaction Questionnaire (OPSAT-Q). Patients completed OPSAT-Q at the baseline visit before the change of therapy (visit 1) and 6 months after the change of therapy (visit 2). Following 6 months ibandronate therapy, the values in all four domains of the OPSAT-Q (convenience, confidence with daily activities, overall satisfaction, side effects) as well as in the Composite Satisfaction Score were higher in visit 2 (
p
< 0.001). Values in subjects enrolled into the patient assistance programme did not differ significantly from the values in subjects that were not (
p
= 0.399) except for the domain convenience (
p
= 0.026). This study demonstrates significantly higher satisfaction in patients who switched from the weekly bisphosphonate therapy regimen to monthly ibandronate in all observed aspects of treatment. Patients expressed preference for monthly bisphosphonate (ibandronate) in comparison with weekly bisphosphonates and found it to be a more convenient method of treatment. At the time of study, however, it was not known that the anti-fracture effect of ibandronate was smaller for hip fractures than with other bisphosphonates.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Objective. The present study was designed to assess the effect of monthly ibandronate on health-related quality of life (HR-QoL) in patients with postmenopausal osteoporosis previously treated with ...weekly bisphosphonates. Methods. HR-QoL was assessed by Euroqol (EQ-5D) and Osteoporosis Targeted Quality of Life (OPTQoL) questionnaires. Results. The EQ-5D questionnaire showed significant improvement associated with ibandronate treatment, occurring in mobility (p < 0.01), usual activity (p < 0.01), pain discomfort (p < 0.05), and anxiety depression (p < 0.05). In addition, ibandronate treatment considerably improved patients' perceived health on a visual analog scale (p < 0.001). For the OPTQoL questionnaire, patients reported less physical difficulty (p < 0.001), fewer adaptations in their lives (p < 0.001), and less fear (p < 0.001) with ibandronate than with weekly bisphosphonates. Conclusion. The study demonstrated that patients who were transferred from weekly bisphosphonates to a monthly ibandronate experienced improved HR-QoL.
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DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Uspješnost zanošenja ovisna je o nizu čimbenika koji posredno moderiraju donošenje živog i vitalnog djeteta. Unatrag pedesetak godina cijeli slijed parametara koji opisuju reprodukciju i njene ishode ...u Europi pokazuju silazni trend. Uz biološke odrednice (ovulacija, kvaliteta sjemena, frekvencija koitusa, stopa oplodnje, spontani gubitak trud¬noće), najbolji demografski pokazatelji plodnosti su stopa živorođenih dizigotnih blizanaca, stopa ukupnog fertiliteta (total fertility rate, TFR; Hrvatska 2003: 1,33) i stopa obnavljanja ženskog stanovništva (Hrvatska 2001:0,66). Najniži prirodni prirast (PP) Hrvatska je zabilježila 2003. godine (–2,1). Daljnji negativno eksponencijski trend u smislu broja, dobi i odnosa spolova će se i dalje nastaviti te će u odnosu na 2001., 2031. godine u Hrvatskoj živjeti 17% manje stanov¬nika.
Uzroci nekoć idiopatskog infertiliteta danas su prepoznati u životnoj dobi i čimbenicima koji su sastavnice načina života.¬ Oni podjednako utječu na uspješnost metoda potpomognute oplodnje. Tjelesna težina, pušenje, i dob su značajno povezani s neplodnošću, dok prehrana, tjelesna aktivnost, psihološki stres, kofein i alkohol u većoj ili manjoj mjeri utječu na zdravlje i posredno na reprodukcijsku sposobnost. Rastuća životna dob u kojoj žena zanosi učetverostručuje rizik za neplodnost te za 50% povisuje perinatalni mortalitet kao jedan od značajnih pokazatelja zdravstvene skrbi uopće.
A 47-year-old man was admitted to the hospital with a pleuritic pain, dyspnea, nonproductive cough and low-grade fever. An ECG documented a sinus tachycardia with S1Q3T3 pattern and incomplete right ...bundle branch block, and lung scintigraphy showed multiple perfusion defects. The initial diagnosis was pulmonary embolism. Echocardiography, undertaken before application of the anticoagulant therapy because of hematological disturbances reflecting possible coagulopathy (elevated erythrocyte sedimentation rate, increased leukocyte count, decreased platelet count), revealed a large mobile tumor in the right atrium. Tumor was surgically removed, and histological findings was supported a diagnosis of the cardiac myxoma. The right cardiac myxoma should be considered in the differential diagnosis of pulmonary embolism, particularly in cases presented in conjunction with constitutional symptoms and/or hematological disturbances. In these patients echocardiography should be undertaken early to exclude the rare but treatable diseases of the right heart.
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