Definicija i klasifikacija velikih nesreća na razine su osnova za donošenje odluka u realnim situacijama. Najvažniji resurs je osoblje, koje mora biti educirano i imati plan za djelovanje u kriznoj ...situaciji. Stručna edukacija medicinskog osoblja i djelatnika drugih hitnih službi koji se nalaze u lancu zbrinjavanja ključni je čimbenik pravilnog i adekvatnog odgovora na veliku nesreću. Edukacija mora biti sprovedena prema objektivnim podacima i
validirana. Optimizacija resursa u odgovoru na veliku nesreću je bitan čimbenik. Hitne službe (policija, vatrogasci, medicinari, djelatnici civilne zaštite) sudjeluju u lancu zbrinjavanja na veliku nesreću prema standardnim operativnim postupcima i pravilnicima o postupanju u kriznim situacijama. Prema programu Kriznog stožera Ministarstva zdravstva Republike Hrvatske sprovodi se kontinuirana medicinska edukacija od 2013. godine uz primjenu međunarodnog poslijediplomskog tečaja: Medical Response to Major Incidents – MRMI.
Uvod: S prevalencijom od 0,005% svih karcinoma, karcinom paratireoidne žlijezde jedna je od najrjeđih malignih bolesti koja zahvaća oko 1% bolesnika s primarnim hiperparatireoidizmom. Pojavljuje se ...sporadično ili u sklopu genetskog sindroma. Više od 90% karcinoma paratireoidne žlijezde su hormonski funkcionalni i dovode do hipersekrecije parathormona, što uzrokuje izrazitu hiperkalcijemiju. Zbog sličnih simptoma s benignim uzrocima hiperparatireoze otežano je preoperativno dijagnosticiranje karcinoma paratireoidne žlijezde. Ultrazvuk vrata i scintigrafija s Tc-99m MIBI mogu pomoći u lokalizaciji bolesti, dok se citopunkcija prije primarne operacije ne preporučuje. Primarni modalitet liječenja je potpuna kirurška resekcija s mikroskopski negativnim rubovima i nudi najbolju šansu za izlječenje. Do sada ne postoje dokazi o učinkovitosti kemoterapijskog ili radioterapijskog pristupa. U više od 50% bolesnika dolazi do razvoja recidiva bolesti, kada je ponovna kirurška resekcija najbolji način liječenja koje tada, rijetko kurativno, služi u svrhu ublažavanja metaboličkih poremećaja i komplikacija hiperkalcijemije koje su glavni uzrok letaliteta. Prikaz bolesnice: Šezdesetogodišnja žena s nizom komorbiditeta upućena je od strane nefrologa sa sumnjom na adenom paratireoidne žlijezde. Po učinjenoj ultrazvučnoj i citološkoj obradi ekstirpira se desna donja paratireoidna žlijezda, te se patohistološkom analizom postavi dijagnoza karcinoma paratireoidne žlijezde, što posljedično indicira reoperaciju. Prije reoperacije učinjena je scintigrafija koja ukazuje na hiperfunkcijsko paratireoidno tkivo, te se u sklopu reoperacije učini desnostrana lobektomija štitnjače i ekstirpacija desne gornje uvećane paratireoidne žlijezde s disekcijom regije VI. Patohistološkom obradom izolira se uredno tkivo štitnjače, adenom paratireoidne žlijezde i jedan hormonski aktivni metastatski limfni čvor iz regije VI. Karcinom paratireoidne žlijezde je izrazito rijedak entitet koji zahtijeva operativnu intervenciju i cjeloživotno praćenje vrijednosti serumskog kalcija i parathormona. Kako bi se unaprijedilo i standardiziralo liječenje bolesnika s karcinomom paratireoidne žlijezde, potrebne su daljnje multicentrične studije.
Introduction: With a prevalence of 0.005% of all cancers, parathyroid carcinoma is one of the rarest malignancies affecting approximately 1% of patients with primary hyperparathyroidism. It can occur sporadically or as part of a genetic syndrome. More than 90% of parathyroid carcinomas are hormonally functional and lead to hyper secretion of parathyroid hormone, which causes marked hypercalcemia. Due to similar symptoms with benign causes of hyperparathyroidism, preoperative diagnosis of parathyroid gland cancer is difficult. Neck ultrasound and Tc-99m MIBI scintigraphy can help localize the disease,while fine needle aspiration before primary surgery is not recommended. The primary treatment modality is complete surgical resection with microscopically negative margins and offers the best chance for recovery. So far, there is no evidence of the effectiveness of chemotherapy or radiotherapy. In more than 50% of cases the disease relapses and surgical resection is the best way of treatment, which is then rarely curative and serves the purpose of mitigating metabolic disorders and complications of hypercalcemia, which are the main cause of mortality. Case report: A 60-year-old woman with a number of comorbidities was referred by a nephrologist with suspicion of parathyroid adenoma. After ultrasound and cytological processing, the right lower parathyroid gland was extirpated, and the pathohistological analysis established the diagnosis of carcinoma of the parathyroid gland, which consequently indicated reoperation. Before the reoperation, a scintigraphy was performed, which indicated hyperfunctioning parathyroid tissue, and as part of the reoperation, a rightsided thyroid lobectomy and extirpation of the right upper enlarged parathyroid gland with dissection of region VI were performed. Pathohistological processing isolated normal thyroid tissue, adenoma of the parathyroid gland and one hormonally active metastatic lymph node from region VI. Carcinoma of the parathyroid gland is an extremely rare entity that requires operative intervention and lifelong monitoring of serum calcium and PTH values. Further multicenter studies are needed to improve and standardize the treatment of patients with parathyroid carcinoma.
Postaviti dijagnozu zloćudne bolesti tijekom prvog pregleda bolesnika u hitnoj ambulanti nije jednostavno. Ako tijekom obrade proširenosti bolesti posumnjamo na inoperabilnost karcinoma, ...metastaziranje ili drugu zloćudnu novotvorinu, zadatak postaje još teži. Nedostatak protokola za aktivno liječenje bolesnika s dva sinkrona karcinoma udaljenih regija predstavlja veliki problem kod rijetkih bolesnika. Bolesnica u dobi od 64 godine javila se u hitnu ambulantu zbog promuklosti i razvoja obostrane otekline na vratu. Postavili smo dijagnozu karcinoma epiglotisa s obostranim metastazama u vratu. U sklopu obrade bolesnice uočili smo neočekivanu hipovaskularnu leziju jetrenog parenhima te smo dijagnosticirali kolangiokarcinom jetre. S obzirom na dva sinkrona karcinoma, bolesnicu smo uputili multidisciplinarnom onkološkom timu koji je indicirao konkomitantnu kemoradioterapiju, a liječenje je još uvijek u tijeku. Dva sinkrona karcinoma udaljenih regija izrazito su rijetka. Pretraživanjem baza podataka Pubmed i Google Scholar opisan je još samo jedan slučaj istovremenog karcinoma grkljana i kolangiokarcinoma u kojem nije provedeno aktivno liječenje, već samo palijativna skrb. Slučaj naše bolesnice pokazuje kako postoje terapijske opcije koje mogu produljiti život i poboljšati kvalitetu života takvih bolesnika.
Diagnosing a malignant disease during the first examination of a patient in an emergency room is very challenging. If the cancer is metastatic or inoperable; or another malignancy is suspected, the task becomes even more difficult. The lack of a protocol for the active treatment of patients with two synchronous cancers in distant regions is a major problem for rare patients. A 64-year-old patient presented to the emergency department with hoarseness and bilateral neck swelling. We diagnosed an epiglottic carcinoma with bilateral neck metastases. As part of the cancer staging, an irregular hypovascular lesion in the liver parenchyma was observed. Diagnosis of an intra hepatic cholangiocarcinoma was set. Due to synchronous malignancies, the patient was referred to a multidisciplinary oncology team, indicating concomitant chemoradiotherapy with ongoing treatment. Two synchronous carcinomas of distant regions are extremely rare. By searching the Pubmed and Google Scholar databases, only one case of synchronous laryngeal carcinoma and cholangiocarcinoma was described in the literature in which no active treatment was performed, only palliative care. This case shows that there are therapeutic options that can prolong life and improve the quality of a life in such patients.
Esophageal achalasia is a primary esophageal motility disorder. Commonly used treatments are botulinum toxin injections, endoscopic balloon dilation and surgical myotomy with or ...withoutfundoplication. We are hereby presenting the first case of laproscopic myotomy with fundoplication performed in Croatia. A 32-year old female was admitted to the hospital due to the symptoms of dysphagia, regurgitation, chest pain and weight loss. Upper gastrointestinal tract radiography with contrast and flexible endoscopy confirmed the clinical diagnosis of achalasia. She was treated by the Heller laparoscopic procedure and Dor anterior fundoplication. The patient had a successful recovery and was discharged on the fifth postoperative day. This case shows thatlaparoscopic treatment of achalasia is a feasibile and safe procedure which can be performed even in a small country hospital, but it requires great technical care and experience of the surgeon.
Postaviti dijagnozu zloćudne bolesti tijekom prvog pregleda bolesnika u hitnoj ambulanti nije
jednostavno. Ako tijekom obrade proširenosti bolesti posumnjamo na inoperabilnost karcinoma,
...metastaziranje ili drugu zloćudnu novotvorinu, zadatak postaje još teži. Nedostatak protokola za aktivno
liječenje bolesnika s dva sinkrona karcinoma udaljenih regija predstavlja veliki problem kod rijetkih
bolesnika.
Bolesnica u dobi od 64 godine javila se u hitnu ambulantu zbog promuklosti i razvoja obostrane otekline
na vratu. Postavili smo dijagnozu karcinoma epiglotisa s obostranim metastazama u vratu. U sklopu obrade
bolesnice uočili smo neočekivanu hipovaskularnu leziju jetrenog parenhima te smo dijagnosticirali
kolangiokarcinom jetre. S obzirom na dva sinkrona karcinoma, bolesnicu smo uputili multidisciplinarnom
onkološkom timu koji je indicirao konkomitantnu kemoradioterapiju, a liječenje je još uvijek u tijeku.
Dva sinkrona karcinoma udaljenih regija izrazito su rijetka. Pretraživanjem baza podataka Pubmed i
Google Scholar opisan je još samo jedan slučaj istovremenog karcinoma grkljana i kolangiokarcinoma u
kojem nije provedeno aktivno liječenje, već samo palijativna skrb. Slučaj naše bolesnice pokazuje kako
postoje terapijske opcije koje mogu produljiti život i poboljšati kvalitetu života takvih bolesnika.
Chronic kidney disease (CKD) is a significant public health problem and it is not possible to precisely predict its progression to terminal renal failure. According to current guidelines, CKD stages ...are classified based on the estimated glomerular filtration rate (eGFR) and albuminuria. Aims of this study were to determine the reliability of predictive equation in estimation of CKD prevalence in Croatian areas with endemic nephropathy (EN), compare the results with non-endemic areas, and to determine if the prevalence of CKD stages 3-5 was increased in subjects with EN.
A total of 1573 inhabitants of the Croatian Posavina rural area from 6 endemic and 3 non-endemic villages were enrolled. Participants were classified according to the modified criteria of the World Health Organization for EN. Estimated GFR was calculated using Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI).
The results showed a very high CKD prevalence in the Croatian rural area (19%). CKD prevalence was significantly higher in EN then in non EN villages with the lowest eGFR value in diseased subgroup.
eGFR correlated significantly with the diagnosis of EN. Kidney function assessment using CKD-EPI predictive equation proved to be a good marker in differentiating the study subgroups, remained as one of the diagnostic criteria for EN.
We present a case of acute traumatic optic neuropathy in 54 year old male patient. The patient presented with acute loss of vision in the right eye due to a blunt trauma to the eye. Lid haematoma and ...subconjunctival hemorrhage were present. Fluorescein staining was negative, anterior chamber and lens was clear. Intraocular pressure was normal. Retina and optic nerve head appeared normal on fundoscopy. The vision was "counting fingers at 1 meter" in the right eye. Color test indicated color perception dysfunction of the right eye. Relative afferent pupillary defect (RAPD) was positive. Ocular ultrasound, orbital X ray and CT scan was normal, but visual evoked potentials test was pathologic. The consideration was made whether to treat a patient or not since there are no consensus on the treatment of traumatic optic neuropathy. We decided to treat the patient immediately with the megadoses of steroids following the protocol suggested by Cerovski. The patient responded well to the treatment and recovered vision to normal.
Spontaneous resolution of post-traumatic chronic subdural hematoma is a very rare and unexpected event. It has been rarely reported in the literature, mostly cases of chronic subdural hematoma ...resolution in idiopathic thrombocytopenic purpura. Operative procedure is generally considered the treatment of choice for chronic subdural hematoma. We present a rare case, which did not require an open surgery, i.e. a case of post-traumatic chronic subdural hematoma spontaneous resolution in a 76-year-old female having sustained a fall without classic head injury. The possibility of conservative treatment is extremely rare in patients with chronic subdural hematoma, but it should be considered based on the patient's neurological and physical condition.
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