Motnje glasu, govora in požiranja niso redke, najbolj pa prizadenejo profesionalne uporabnike glasu, otroke in odrasle s prirojenimi anomalijami ali nevrološkimi motnjami ter bolnike po zdravljenju ...raka glave in vratu. Foniater je otorinolaringolog, ki obravnava te motnje. Osnovne preiskave foniatra so endoskopske preiskave grla ter fleksibilna endoskopska analiza požiranja. Kirurški posegi se izvajajo v grlu v splošni ali lokalni anesteziji. V času pandemije covida-19 se je zaradi teh visoko tveganih posegov z nastajanjem aerosola delo foniatra prilagodilo situaciji. Iz preglednih člankov in po stališčih Združenja evropskih foniatrov (angl. Union of the European Phoniatricians, UEP) so povzeta priporočila o načinu in potrebnosti izvajanja diagnostičnih in terapevtskih postopkov. Bistvenega pomena je dosledna uporaba osebne zaščitne opreme, upoštevanje čiščenja in zračenja prostorov ter s tem povezana razpoložljivost zadostnega časa za obravnavo posameznega bolnika. Za vsakega bolnika je potrebna individualna odločitev, ali se preiskava izpelje, ali pa jo je možno vsaj delno nadomestiti z drugo preiskavo, ki ne predstavlja take nevarnosti za prisotne zdravstvene delavce.
Background. Polycystic ovary syndrome (PCOS) is the most common female endocrinopathy of reproductive age affecting 15–22 % of women according to European standards. It is a multisystem ...reproductive-metabolic disorder and its diagnostics and treatment remain controversial. Women with PCOS are at increased risk of developing type II diabetes, metabolic syndrome, cardiovascular disease, depression, non-alcoholic fatty liver disease, endometrial hyperplasia and cancer and few other types of carcinoma. Due to all above, early correct diagnosis, treatment and permanent surveillance of PCOS are of great importance. The main difficulty with diagnosis of PCOS was until recently lack of clear diagnostic criteria. In 2003 the European Society for Human Reproduction and Embryology and the American Society for Reproductive Medicine published a definition of PCOS. For a diagnosis of PCOS two of three criteria have to be met: oligo- or chronic anovulation (less than 8 menses per year or menses that occur at intervals greater than 35 days), clinical or biochemical signs of hyperandrogenism (alopecia, hirsutism, seborrhoea, acne, virilism), polycystyc ovaries seen on vaginal ultrasound (VUS) (presence of 12 or more follicles in both ovaries measuring 2–9 mm in diameter and/or ovarian volume larger than 10 cm3 of either or both ovaries). Exclusion of other diseases with similar clinical presentation is necessary. Treatment depends on the age of the patient, predominating clinical signs and aim we try to achieve. First-line treatment for all patients includes life-style changes and weight reduction in obese patients. Management of adolescent patients is aimed at abolishment of menses irregularity and endometrial protection, treatment of hyperandrogenism, obesity, and insulin resistance (IR). In the first-line treatment we also recommend oral hormonal contraceptives (OHC) with non-androgenic gestagens (NG) with or without antiandrogens (AA) and topical dermatological treatment (TDT) if necessary. In the second-line treatment we recommend gestagens combined with AA an insulin sensitizing agents (ISA). Management of patients in reproductive age, who do not want to conceive, is aimed at endometrial protection and treatment of hyperandrogenism, obesity, IR and metabolic risks. In the first-line treatment we also recommend OHC with NG preferably combined with AA. Antiandrogenic effect could be strengthened by adding ISA, which also reduce risks of developing diabetes and cardiovascular disease. In cases of very distinctive hyperandrogenism TDT is possible. To protect endometrium and prevent conception insertion of intrauterine device with levonorgestrel is appropriate. In perimenopause we prescribe low-dosage hormonal replacement therapy. First-line treatment of patients of reproductive age, who want to conceive, is medicamental or surgical induction of ovulation. Clomiphene citrate (CC) is most suitable for medicamental induction of ovulation. Recommended duration of treatment with CC is up to six months. At least in the first cycle of treatment response of ovaries and endometrium with VUS is advisable. If response is satisfactory and a patient did not conceive after six months of treatment an intrauterine insemination is recommendable. In obese women, if treatment with CC is unsuccessful, addition of ISA is recommended. In case of failure of induction of ovulation we proceed as in other patients with whom the next step is treatment with gonadotrophines given by a step-up protocol or ovary electrocoagulation (OEC), if it has not been performed during management of infertility. The latter is advisable first of all for CC resistant women with high LH serum levels. After six unsuccessful months of treatment with gonadotrophines and OEC assisted reproduction techniques are recommended. Conclusions. Because of its complicated nature management of PCOS remains a challenge. According to most recent guidelines diagnosis of PCOS requires two of three criteria to be met: oligo- or chronic anovulation, clinical or biochemical signs of hyperandrogenism and polycystyc ovaries seen on VUS. Women with PCOS are at increased risk of developing diabetes, cardiovascular disease and certain types of carcinoma. Thus long-term treatment of systemic effects of PCOS is of great importance. The latter also has an important role in treating gynaecological problems because combined treatment together with traditional methods offers even more successful management of patients with PCOS. In the first-line treatment we still recommend life-style changes and weight reduction in obese patients. Further treatment depends on the age, predominating clinical signs and reproductive desires of the patient.
DEEP INFILTRATING ENDOMETRIOSIS Martina Ribič-Pucelj
Zdravniški vestnik (Ljubljana, Slovenia : 1992),
02/2018, Letnik:
78
Journal Article
Recenzirano
Odprti dostop
Background: Endometriosis is not considered a unified disease, but a disease encompassing three differ- ent forms differentiated by aetiology and pathogenesis: peritoneal endometriosis, ovarian ...endometriosis and deep infiltrating endometriosis (DIE). The disease is classified as DIE when the lesions penetrate 5 mm or more into the retroperitoneal space. The estimated incidence of endometriosis in women of reproductive age ranges from 10–15 % and that of DIE from 3–10 %, the highest being in infertile women and in those with chronic pelvic pain. The leading symptoms of DIE are chronic pelvic pain which increases with age and correlates with the depth of infiltration and infertility. The most important diagnostic procedures are patient’s history and proper gynecological examination. The diagnosis is confirmed with laparoscopy. DIE can affect, beside reproductive organs, also bowel, bladder and ureters, therefore adi- tional diagnostic procedures must be performed preopertively to confirm or to exclude the involvement of the mentioned organs. Endometriosis is hormon dependent disease, there- fore several hormonal treatment regims are used to supress estrogen production but the symptoms recurr soon after caesation of the treatment. At the moment, surgical treatment with excision of all lesions, including those of bowel, bladder and ureters, is the method of choice but requires frequently interdisciplinary approach. Surgical treatment significantly reduces pain and improves fertility in inferile patients. Conclusions: DIE is not a rare form of endometriosis characterized by chronic pelvic pain and infertility. Medical treatment is not efficient. The method of choice is surgical treatment with excision of all lesions. It significantly reduces pelvic pain and enables high spontaneus and IVF preg- nacy rates.Therefore such patients should be treated at centres with experience in treatment of DIE and with possibility of interdisciplinary approach.
A low proportion of bystanders in Slovenia are willing to provide resuscitation to people experiencing cardiac arrest. We measured knowledge acquired after cardiopulmonary resuscitation training ...among Slovenian children in the final three grades of primary school.
This pre- and post-test cohort study included 566 schoolchildren aged 12-15 years. From April to May 2018, we administered a 15-item questionnaire to children in 15 primary schools, to assess the effects of theoretical and practical cardiopulmonary resuscitation training on their knowledge of cardiopulmonary resuscitation at 1-2 months after training. Data were processed using univariate, bivariate, and multivariate analyses.
A significantly greater level of post-training knowledge was noted in all three equally sized school grade groups (p=0.001). The youngest group (mean age 12.5 years) exhibited the greatest increase in knowledge, with test scores increasing by an average 2.65 (range 0-15) points. Age (p=0.001), body mass index (p=0.037), female sex (p=0.006), and previous resuscitation training (p=0.024) were significant independent predictors of pre-training knowledge level. Sex was the only predictor significantly influencing knowledge levels after training (p=0.002); girls scored up to 0.7 points higher than boys, both before and after training.
Among Slovenian schoolchildren aged 12-15 years, a significantly improved level of theoretical knowledge was demonstrated after cardiopulmonary resuscitation training. The introduction of cardiopulmonary training may be most effective in children aged 12.5 years (seventh graders). Early, compulsory resuscitation training might reduce social barriers to performing resuscitation, which may eventually translate into better post-cardiac arrest outcomes.
Resekcija jeter (RJ) je ostala glavna oblika terapije pri solitarnem hepatoceličnem raku (HCC), pri bolnikih z ohranjeno funkcijsko rezervo jeter in v primernem splošnem stanju. Izpopolnjene slikovne ...preiskave so pripomogle k boljši izbiri bolnikov. Kirurgija jeter je napredovala: uporabne so številne tehnike transekcije jetrnega tkiva; dosegljive so različne naprave, ki omogočajo hitrejše in natančnejše operiranje v brezkrvnem operativnem polju. Izboljšana kirurška tehnika, vzdrževanje nizkega centralnega venskega pritiska in napredek pri negi bolnika po operaciji so omogočili, da se je smrtnost po operaciji jeter v izbranih serijah znižala celo do 0%. Barcelona Clinic Liver Cancer (BCLC) klasifikacija poleg zamejitve bolezni, nudi priporočila tudi glede izbora terapije. Kirurško terapijo omejuje zgolj na bolnike z zgodnjim stadijem raka. Namen tega prispevka je raziskati, ali je v sedanjem času mogoče RJ opraviti s sprejemljivimi kratko- in dolgoročnimi rezultati tudi pri bolnikih s takšnim HCC, pri katerem so prisotni številni in veliki tumorji, ki makroskopsko vdirajo v žile.
Hud akutni pankreatitis (HAP) je akutna vnetna bolezen trebušne slinavke, ki je še vedno povezana z visoko obolevnostjo in smrtnostjo. Glavna značilnost bolezni je hud sistemski vnetni odgovor ...organizma, ki velikokrat vodi v odpoved več organskih sistemov. Za oceno optimalnega načina zdravljenja je potreben individualni pristop, ki temelji na pozornem spremljanju kliničnih znakov, intenzivnem monitoriranju ter krvnih in slikovnih preiskavah. Infekcijski zapleti dodatno otežijo potek bolezni in pomembno vplivajo na večjo smrtnost pri bolnikih, ki so preživeli prvo vnetno fazo bolezni. Diagnosticiranje okužene nekroze trebušne slinavke je pogosto težavna naloga. Edina jasna indikacija za protimikrobno zdravljenje HAP je dokazana okužena nekroza trebušne slinavke. Če stanje bolnika omogoča, se ta hrani enteralno, v nasprotnem primeru pa parenteralno oziroma kombinirano. Sodobno kirurško zdravljenje HAP temelji na odloženih kirurških posegih, ki naj vključujejo različne minimalno invazivne tehnike. Intenzivno zdravljenje bolnikov s HAP obsega podporno zdravljenje ter preprečevanje zapletov.
Namen raziskave je bil ugotoviti vpliv različnih tehnoloških postopkov predelave grozdja in pridelave vina na fizikalne in kemijske parametre vina ter njegovo senzorično kakovost. Za izvedbo poskusa ...smo izbrali vina sorte malvazija (letnik 2007), pridelana na območju Slovenske in Hrvaške Istre. Vina so pridelana po treh tehnoloških postopkih: klasičnem postopku, z maceracijo drozge in z zorenjem vina na drožeh. Pri nekaterih vzorcih je bila uporabljena kombinacija več postopkov (hladna maceracija in zorenje vina na drožeh). Pri vinih smo določili pH, vsebnost titrabilnih kislin, vsebnost hlapnih kislin, pufrno kapaciteto, sladkorja prostega ekstrakta, vsebnost alkohola, relativno gostoto, vsebnost reducirajočih sladkorjev, vsebnost prostega in skupnega SO2, vsebnost fenolov, taninskih fenolov, intenziteto barve ter vsebnost nekaterih hlapnih aromatičnih snovi. Poleg tega smo vina tudi senzorično ocenili in rezultate statistično izvrednotili. Ugotovili smo, da uporaba različnih tehnoloških postopkov predelave grozdja in pridelave vina značilno vpliva na vse fizikalne in kemijske parametre vina. Analiza korelacijskih koeficientov je pokazala številne pozitivne in negativne korelacije med izmerjenimi parametri. Analiza glavnih komponent je pokazala, da je večina variabilnosti med vzorci posledica različne intenzitete barve ter različnih koncentracij fenolov metanola, etil acetata in izoamil acetata. Pri senzorični analizi so najboljše ocenjena vina, pridelana po tehnologiji zorenja vina na drožeh.
In February 2013, the European Union successfully completed more than 30 years of negotiations and formally signed an agreement establishing a single European patent. The agreement brought about a ...more competitive patent law compared with that in the United States and Japan. The agreement resulted in a number of advantages, especially for small and medium-sized enterprises, such as the reduction of costs by as much as 80%, simplification of procedures, and the adoption of the Unified Patent Court. With the new unitary patent, intellectual property will grow in importance. Yet experts warn that the new patent results in new forms of unwanted behavior, such as forum shopping and the emergence of patent trolls. This study presents both sides-the pros and cons-to predict the effects on business and cover the widest possible range of experts, providing their views on the topic.
Evropska unija je februarja 2013 uspešno zaključila več kot tridesetletna pogajanja in uradno podpisala sporazum o uvedbi enotnega evropskega patenta. Sporazum prinaša bolj konkurenčno patentno pravo v primerjavi z ameriškim in japonskim. V dogovoru je predvidena vrsta prednosti, predvsem za mala in srednje velika podjetja. Ključne so: zmanjšanje stroškov za kar 80 %, poenostavitev postopkov in uvedba enotnega patentnega sodišča. Intelektualna lastnina bo z enotnim patentom pridobila pomen. Toda strokovnjaki opozarjajo, da lahko novi patent povzroči nove oblike neželenega vedenja, kot sta izbira najugodnejšega sodišča (ang. forum shopping) in pojav patentnih škratov. V raziskavi želim predstaviti predvsem obe plati, prednosti in slabosti, predvideti, kakšne učinke bodo imele na poslovanje podjetij, zajeti čim širši krog strokovnjakov ter prikazati njihove poglede na tematiko.
Evropska unija je februarja 2013 uspešno zaključila več kot tridesetletna pogajanja in uradno podpisala sporazum o uvedbi enotnega evropskega patenta. Sporazum prinaša bolj konkurenčno patentno pravo ...v primerjavi z ameriškim in japonskim. V dogovoru je predvidena vrsta prednosti, predvsem za mala in srednje velika podjetja. Ključne so: zmanjšanje stroškov za kar 80 %, poenostavitev postopkov in uvedba enotnega patentnega sodišča. Intelektualna lastnina bo z enotnim patentom pridobila pomen. Toda strokovnjaki opozarjajo, da lahko novi patent povzroči nove oblike neželenega vedenja, kot sta izbira najugodnejšega sodišča (ang. forum shopping) in pojav patentnih škratov. V raziskavi želim predstaviti predvsem obe plati, prednosti in slabosti, predvideti, kakšne učinke bodo imele na poslovanje podjetij, zajeti čim širši krog strokovnjakov ter prikazati njihove poglede na tematiko.
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