SAŽETAK
Rak dojke je najčešći zloćudni tumor u žena koji se može probirom, redovitim kontrolama i zdravstvenim odgojem otkriti u ranim stadijima bolesti i uspješno liječiti. Metode liječenja ...uključuju kirurgiju, kemoterapiju, radioterapiju, endokrinu terapiju, imunoterapiju, ciljanu terapiju te simptomatsko-suportivnu terapiju, koja se primjenjuje ovisno o stadiju bolesti, biološkim obilježjima tumora i općem stanju, dobi i komorbidetima bolesnica. Plan liječenja definira multidisciplinarni tim. S obzirom na pojavnost ove bolesti, mogućnost ranog otkrivanja i mogućeg značajnog učinka terapijskih postupaka na tijek bolesti, potrebno je definirati i pravilno standardizirati pristup u dijagnostici, liječenju i praćenju ovih bolesnica. U tekstu su iznesene smjernice s ciljem primjene standardiziranih postupaka u svakodnevnom radu s bolesnicama s rakom dojke u Republici Hrvatskoj.
In this restrospetive study, data on 272 coronary artery disease patients with concomitant diabetes mellitus treated between 12/1997 and 12/2002 were analyzed. Eighty patients inderwent complete ...arterial revascularization (DM-ART), whereas 192 patients underwent coronary revascularization using arterial-venous grafts (DN-NEART). The following preoperative data and risk factors were analyzed: arterial hypertension, hyperlipoproteinemia, number of vessels involved, left coronary artery stenosis, unstable angina, previous myocardial infarction (MI), previous cardiac surgery, EuroScore. During a 30-day postoperative period, the following complications were analyzed: bleeding, perioperative MI, wound infection, sternal dehiscence, neurologic dysfunction, mortality. DM-ART patients had a higher rate of hyperlipoproteinemia (p=0.004). Difference was only found for the occurrence of perioperative MI in DM-NEART group (p<0.001). Total arterial revascularization without cardiopulmonary bypass is a reliable and safe choice in patients with concomitant diabetes mellitus irrespective of its type. Definitive conclusions can only be made after five- or ten-year evaluation of postoperative mirbidity and mortality.
The use of arterial grafts combined with the off-pump coronary artery bypass (OPCAB) procedure offers many advantages, but most of them are still to be proven in long-term studies. We present our ...5-year experience in combining these 2 strategies in coronary surgery.
From February 1998 to December 2002 we operated on 155 patients (146 men and 9 women) for multiple arterial graft myocardial revascularization. All procedures were performed as OPCAB grafting using internal mammary and radial arteries. The mean +/- SD was 58 +/- 9 years for patient age, 57% +/- 11% for left ventricle ejection fraction, and 2.3 +/- 1.9 for the EuroSCORE. We reviewed perioperative and postoperative data and in-hospital mortality in our patients.
A total of 356 distal anastomoses were created, an average of 2.3 per patient. The left internal mammary artery was used as a graft in 153 patients (98%), the right internal mammary artery was used in 13 patients (8%), and the radial artery was used in 146 patients (94%). No venous grafts were used. There were 4 reopenings (2.6%) because of mediastinal bleeding. Four patients (2.6%) experienced perioperative myocardial infarction, and 2 patients (1.3%) had permanent neurologic dysfunction. Five patients (3.2%) died in the hospital within 30 days of the operation.
Our experience shows that arterial myocardial revascularization can be safely performed as an OPCAB procedure, even in the treatment of multiple-vessel coronary disease. The long-term benefit for patients is to be evaluated in the future.
Nephrotic syndrome may persist despite end-stage kidney disease and result in dyslipidaemia, thrombosis and a significantly increased cardiovascular risk. Treatment of refractory nephrotic syndrome ...includes surgical bilateral nephrectomy, renal artery embolization and pharmacologic nephrectomy.
We present a case of a haemodialysis patient with refractory nephrotic syndrome who underwent pharmacologic nephrectomy. The procedure decreased the patient's cardiovascular risk and enabled the patient to become a candidate for kidney transplantation.
In certain situations residual renal function may be harmful. In such instances, nephrectomy should be considered. Pharmacologic nephrectomy using nephrotoxic drugs is a non-invasive approach with least potential complications.
This article presents geotechnical reconnaissance data that characterize the formation of 122 new and 49 historical cover-collapse sinkholes within 1.13 km2 area in 12 months following the MW 6.4 ...earthquake that occurred on 29 December 2020, in Petrinja, Croatia. Data include a geological background, seismic sequence information, sinkhole geometric characteristics, rainfall data, and results of detailed geotechnical subsurface investigation. The sinkhole geometrical features were collected using aerial and satellite imagery, terrestrial lidar, and manual measurements. Soil properties and groundwater levels were obtained from four geotechnical boreholes, accompanied by in situ geotechnical characterization and standard penetration tests (SPTs). Soil parameters were obtained from consolidated undrained conventional triaxial compression, oedometer, soil water retention, and index tests performed on 31 soil samples. Clayey cover, 4-10 m thick, with sporadic gravel lenses overlying cavernous, intensely karstified carbonate rocks, characterizes the sinkhole area. Clays are mostly overconsolidated, with varying degrees of saturation ranging from very small to fully saturated. Seasonal and climate-induced variations in the groundwater table interact with artesian/subartesian karst aquifer, thus affecting the suction and the shear strength. Soil water retention curves (SWRCs) indicate that desaturation is possible for deeper groundwater tables, thus further affecting the effective stress, shear strength, and interparticle tensile forces. Finally, the observed vertical walls that accompanied sinkholes opening can occur in the overconsolidated cohesive cover clay layer with varying degree of saturation. The presented data provide essential geomechanical information necessary to understand the associated sinkhole failure mechanism. This article will help future investigators to perform detailed analyses and provide a background for complementing future sinkhole precursor research. Geotechnical, geological, seismic, and precipitation data generally indicate that the formation of cover-collapse sinkholes in the study area is a consequence of a specific local geological setting but is significantly expedited by earthquake-induced dynamic loading and complemented by multiple hydro-mechanical factors.
