Izhodišča: Kronični endometritis (KE) poteka z blagimi kliničnimi znaki in naj bi bil povezan z neplodnostjo, s ponavljajočimi se splavi in ponavljajočo se neuspelo ugnezditvijo zarodka v postopkih ...oploditve z biomedicinsko pomočjo (OBMP). Ker si mnenja o ugotavljanju in zdravljenju KE v postopkih OBMP medsebojno nasprotujejo, smo si zastavili cilj sistematično pregledati članke o vplivu zdravljenja KE na reproduktivni izid pri neplodnih ženskah v postopkih OBMP.
Metode: Pregledali smo zbirko Medline. Uporabili smo deskriptorje iz tezavra Medical subject headings (Mesh), ki so vključevali ključne besede kronični endometritis (angl. chronic endometritis) in zdravljenje (angl. treatment) ter nosečnost (angl. pregnancy). Vključili smo raziskave od januarja 1971 do marca 2022.
Rezultati: V pregled smo vključili 8 raziskav, ki so uporabile različne sheme zdravljenja. Večina raziskav je ugotavljala statistično pomembne razlike v reproduktivnem izidu po zdravljenju KE.
Zaključek: Zdravljenje KE lahko pozitivno vpliva na izid v sledečih si OBMP postopkih, vendar so še potrebne nadaljnje večje randomizirane študije.
Epidemiološki kazalci kažejo, daje rak v Sloveniji veliko javnozdravstveno breme. Rak je med vzroki smrti na prvem mestu pri moških in na drugem mestu pri ženskah. Za zagotavljanje primerne oskrbe ...bolnikov z rakom v bodoče je nujna primerna kadrovska zasedba, saj zadostni in primerno usposobljeni človeški viri predstavljajo osnovo za celostno izvajanje onkološke oskrbe v Sloveniji. V okviru Ciljnega raziskovalnega projekta Analiza stanja in ocena kadrovskih potreb za izvajanje zdravljenje raka v Republiki Sloveniji je bil razvit fleksibilen napovedovalni model za načrtovanje potrebnega zdravstvenega osebja za zdravljenje raka in paliativno oskrbo onkoloških bolnikov. Narejena je bila ocena kadrovskih potreb za kratkoročno obdobje do 2021 ter dolgoročno obdobje do leta 2030. V rezultatih so prikazane ocene kadrovskih potreb na podlagi podatkov o številu novih primerov raka za vse rake skupaj in za pogoste rake, to je rak debelega črevesa in danke, rak pljuč, rak dojke, rak prostate ter skupaj za ostale rake. Kadrovske ocene za izvajanje zdravljenje raka so bile izračunane za vsako navedeno lokacijo raka glede na vrsto zdravljenja ter po poklicnih skupinah v zdravstvu. Kadrovske potrebe za paliativno oskrbo so bile narejene na podlagi podatkov o umrljivosti za vse rake skupaj po nivojih paliativne oskrbe. Predstavljena metodologija omogoča različnim deležnikom v kratkoročnem 5-letnem obdobju hitre izračune letnih kadrovskih potreb le na podlagi podatkov o incidenci in umrljivosti, na daljša obdobja in v primeru večjih sprememb v zdravstvenem sistemu pa omogoča poglobljeno analizo kadrovskih potreb in testiranje različnih scenarijev.
Elbow stiffness may develop due to various causes but most frequently it is secondary to a traumatic elbow lesion or heterotopic ossification common after head or spinal trauma. Both open and ...arthroscopic releases are effective. The arthroscopic release is reserved for intra-articular and capsular reasons, while open surgery can address either intra-articular or extra-articular causes. Different surgical approaches are used to treat elbow stiffness, depending on the exact anatomical location of the lesion that limits the range of movements. Complications are rare, the most frequent being incomplete resolution of stiffness. Nerve lesions are very rare. Most frequent is a partial ulnar nerve lesion, especially when nerve release or transposition is required. Conservative treatment with static or dynamic braces can be effective when there are no anatomical reasons for stiffness. Braces can be used as an adjunct to surgical treatment in the postoperative period in selected cases where no bony impingement is present.
Kirugija glave in vratu med pandemijo covida-19 Zore, Sara Bitenc; Šifrer, Robert; Mavrič, Ajda ...
Zdravniški vestnik (Ljubljana, Slovenia : 1992),
02/2022, Letnik:
91, Številka:
1-2
Journal Article
Recenzirano
Odprti dostop
Kirurgija glave in vratu med pandemijo covida-19 je za zdravstveni sistem velik izziv. Pred kirurškimi posegi je potrebna ustrezna priprava in poznavanje vseh možnosti zdravljenja, da bolnik in ...zdravstveni delavci ne tvegajo okužbe. Treba je odložiti vse posege, katerih odložitev ne ogroža bolnikovega zdravja. Operacijske posege glede na nujnost delimo v tri skupine – v prvo skupino sodijo urgentni, neodložljivi posegi, v drugo skupino posegi, ki jih lahko odložimo za največ štiri tedne, in v tretjo skupino posegi, katerih odložitev za šest do osem tednov ne vpliva na izid zdravljenja. Pred predvideno operacijo je treba ugotoviti status okužbe bolnika z virusom SARS-CoV-2, razen ob urgentnih posegih, ki jih opravimo ne glede na status okužbe bolnika. Kirurški posegi glave in vratu se med seboj razlikujejo glede na možnost prenosa okužbe z virusom SARS-CoV-2 s pozitivnega bolnika na zdravstvenega delavca; pri tem upoštevamo predvsem verjetnost tvorbe aerosola med posegom. Med posege največjega tveganja sodijo endoskopske preiskave zgornjih dihal in prebavil ter žlez slinavk in operacije v tem področju, ki prekinejo sluznice. Te so: traheotomija, laringektomija, faringektomija, operacija raka ustne votline, transoralna laserska mikrokirurgija, transoralna robotska kirurgija. V skrbi za zdravje zdravstvenega osebja in bolnikov je med kirurškimi posegi nujna dosledna uporaba osebne varovalne opreme ne glede na okuženost bolnika.
V prispevku predstavljamo anorektalne malformacije. Kirurško zdravljenje danes omogoča, da lahko novorojenček neovirano odvaja blato. Če dokončne enostopenjske rekonstrukcije ne moremo izvesti, je ...potrebna večstopenj-ska obravnava z izpeljavo stome. Praviloma velja, da imajo otroci z manj kompleksnimi malformacijami kasneje večjo možnost nadzora nad odvajanjem blata, a žal tudi večje tveganje zaprtja, medtem ko imajo otroci z bolj kompleksnimi malformacijami slabše razvite mišice ter spremenjeni motiliteto in senzibiliteto z manjšo možnostjo vzpostavitve popolne kontinence za blato. Po operaciji moramo poskrbeti za redno spremljanje in preprečevanje zaprtja. Vzpostaviti moramo dosledni ritem odvajanja, kar dosežemo s prehranskimi prilagoditvami ali z uporabo odvajal. Ob uhajanju blata se lahko poslužujemo klistiranja, ki ga vedno prilagodimo posamezniku. Inkontinenca za blato kot posledica operativnega posega je redkost.
Background. For urinary incontinence there are different treatment options available and among them we are in favor of those, which are the least aggressive and are similarly efficient at the same ...time. In the last decade there has been an increasing body of evidence suggesting that the functional magnetic stimulation (FMS) might be a new and promising treatment modality for treating of women with urinary incontinence. FMS has been applied to pelvic floor therapy and the treatment of urinary incontinence for the first time in 1999. Contrary to electrical stimulation, FMS aims to stimulate the pelvic floor muscles without insertion of a vaginal probe. During the treatment patient is positioned in a special chair. Under the seat is a magnetic field generator which is producing a pulsating magnetic field which is penetrating the perineum. Structures such as pudendal nerves can therefore be magnetically stimulated without patient’s discomfort or inconvenience of probe insertion as it may be true for electrical stimulation. One of the drawbacks of FMS with magnetic chair is the need for repeated office-based treatment, what may represent a major burden for patients and also for national healthcare system. Therefore we developed a new small magnetic stimulator producing electromagnetic pulses which penetrate either the perineum or pubic bone and thus stimulate the pelvic floor and detrusor muscle. One of advantages of this small portable stimulator apart of its clinical eficacy is a continuous 24-hours stimulation which can be performed either at home/work or during different activities. Conclusions. In this article we are presenting the literature overview regarding magnetic stimulation including our initial experiencies with this new treatment method. Based on our clinical results we feel that FMS represents a new and noninvasive treatment method for urinary incontinence.
Background. The aim of our retrospective study was to collect and compare data on hormone replacement therapy prescription in Slovenian women before the first diagnosis of breast cancer and the ...control group of randomly selected healthy women matched by age. Patients and methods. We carried out a cross-sectional, case-control study and enrolled 1408 women aged between 50 and 69 years. They were invited to participate via a personal letter and asked to complete written questionnaire. Besides questions regarding drug intake of sex hormones and general information, questionnaire contained questions that provide reproductive data and family history of cancer. We used the independent t-test to compare the values of the means between the two groups and the chi-square statistic to determine an association for categorical data between groups. Results. In our study, significantly more women in the control group were using HRT. Although, there was not statistically significant difference in the proportion of women between the control and the experimental group using HRT for more than 5 years. There was higher proportion of women in the experimental group receiving combined HRT, but the difference was not statistically significant. Furthermore, there was also significantly higher proportion of women in the experimental group receiving systemic HRT and significantly higher proportion of women in the control group receiving local HRT preparations. Conclusions. HRT is still the most efficient way to treat debilitating menopausal symptoms. Although the linkage between the use of HRT and increased breast cancer risk is physiologically plausible, our preliminary results show that observable risk is moderate.
Background: To obtain a complete diagnosis of preinvasive cervical lesions, the results of cytology, col- poscopy and histological biopsy are needed. Low-grade lesions (LG-SIL, CIN 1) should be ...managed conservatively because such lesions can regress. Treatment is suggested if the abnormality persists for 2 years or if the lesion worsens in grade or size. High-grade lesions (HG-SIL, CIN 2 and 3) are managed by different treatment modalities. Ablative modalities include cryocautery, electrocoagulation diathermy and laser ablation. For ablative treat- ment only ectocervical lesions with entirely visible squamocolumnar junction visible are suitable. Small localized lesions of CIN 1 and 2 may be treated by cryocautery or electroco- agulation diathermy. Lesions entering the cervical canal cannot be destroyed with certainty. Laser destroys the tissue by evaporation and coagulation, and is useful if the dysplastic areas extend into the vaginal fornices. Excision modalities including loop diathermy excision, cold-knife conization, laser cone biopsy and hysterectomy provide specimens for histology. Loop diathermy excision is currently the most common treatment modality. Cold-knife conization is performed with a scalpel. The cone can be broad and shallow or narrow and deep, depending on the location and the size of the lesion. Laser cone biopsy is relatively costly and time-consuming. Histopathology aims to assess the nature of the lesion and to determine whether it has been removed completely. Conclusions: Treatment of preinvasive lesions is not completely harmless for the patient. Complications include hemorrhage, cervical stenosis or incomplete excision. Hysterectomy should be con- sidered for a patient with CIN suffering from menorrhagia, uterine prolapse or leiomyomas as well as in cases of adenocarcinoma in situ, when the reproductive function has been completed.
The objective of this study was to assess pre-treatment quality of life and the relevant clinical variables in adult patients with malocclusion in order to improve orthodontic treatment strategies.
...The study was conducted in 240 consecutive adult patients with malocclusions divided into two groups: patients for whom an orthodontic treatment plan was considered, and patients for whom an orthognathic treatment plan was selected. Patients were examined between December 2015 and February 2017, at the School of Dental Medicine, University of Belgrade. Malocclusion severity was recorded using the Peer Assessment Rating index pre-treatment score. Skeletal malocclusion parameters were measured using lateral cephalometric radiographs. Quality of life was assessed by means of a generic questionnaire (Medical Outcomes Study Short Form-36 (SF-36)), and the disease-specific Orthognathic Quality of Life Questionnaire (OQLQ).
There were significant differences in the mean values of the OQLQ domain scores between orthodontic and orthognathic patients. Patients for whom orthodontic treatment was planned had statistically significantly lower scores in comparison to those for whom orthognathic treatment was planned. This was the case in all OQLQ domains except for "Awareness of facial deformity". Statistically significant correlations (p<0.05) were presented between OQLQ scores and following demographic and clinical variables: gender, age, malocclusion severity, maxillary and mandibular sagittal, maxillary vertical, and lower incisor positions, intermaxillary angle, and the Beck Depression Inventory and Beck Anxiety Inventory levels. The independent predictors for the planning of orthodontic and orthognathic treatment in patients with malocclusion were two OQLQ domains, "Facial aesthetics" and "Awareness of facial deformity", as well as total OQLQ score, after adjustment for demographic characteristics, skeletal parameters, anxiety and depression.
Our findings suggest that patients for whom orthodontic treatment was planned demonstrated better quality of life according to the OQLQ scores in comparison to those for whom orthognathic therapy was planned.
Izhodišča: Duktalni adenokarcinom trebušne slinavke (PDAC) je ena najbolj smrtonosnih rakavih bolezni. V naši raziskavi smo želeli ovrednotiti povezavo zunajceličnih veziklov (ZV) iz krvne plazme s ...celokupnim preživetjem bolnikov s PDAC, ki so bili kirurško obravnavani.
Metode: V retrospektivno raziskavo smo vključili 32 preiskovancev s postavljeno diagnozo PDAC, ki so bili kirurško obravnavani na KO za abdominalno kirurgijo UKC Ljubljana. Za vsakega preiskovanca smo pridobili klinične podatke, laboratorijske izvide, histopatološko analizo in vzorec krvne plazme. ZV smo osamili iz plazme preiskovancev in določili njihovo koncentracijo in velikost.
Rezultati: Preiskovance smo glede na tip kirurške obravnave razdelili na skupino z opravljeno resekcijo tumorja in skupino z opravljeno eksploracijo brez resekcije. Pokazali smo, da so ZV v krvni plazmi bolnikov z eksploracijo značilno večji od ZV bolnikov z resekcijo (p < 0,05). Z analize ROC smo določili mejne vrednosti velikosti ZV, ki so ločile preiskovance glede na tip kirurške obravnave. Pri mejni vrednosti 183,3 nm za povprečno velikost ZV je za napoved resekcije občutljivost 0,591 in specifičnost 0,900 s površino pod krivuljo 0,77 (95 % CI = 0,60–0.93, p = 0,016). Preiskovanci z večjimi ZV so imeli slabše celokupno preživetje (p < 0,05), pri čemer je bilo preživetje preiskovancev s povprečno velikostjo ali mediano velikosti ZV večje od mejne vrednosti za 13,8 mesecev slabše (p < 0,05).
Zaključek: V sklopu raziskave smo pokazali povezavo med velikostjo ZV in celokupnim preživetjem bolnikov s PDAC, ki so bili kirurško obravnavani. S tem smo pokazali potencial ZV kot dodatnih bioloških označevalcev za personalizirani pristop k zdravljenju bolnikov s PDAC.
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