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Systemic Lupus Erythematosus Treatment in Pregnancy: Case Study 妊娠期系统性红斑狼疮治疗:个案研究
Pub Date : 2020-08-01 DOI: 10.2478/acm-2020-0010
Z. Laučeková, K. Bodova, M. Ňachajová, E. Kudela, R. Fiolka, D. Prídavková, K. Stašková, K. Biringer
Abstract Systemic lupus erythematosus is a chronic inflammatory autoimmune disease with high prevalence in female in reproductive age. In recent years the prognosis of pregnant patients with SLE has improved significantly. Even though the treatment options have improved, the risk of flares, preeclampsia, pregnancy loss, and premature labours remains high compared to healthy women. The aim of this article is to offer a review of current treatment options in pregnant patients with SLE and to present a case report of 32-year-old patient with newly diagnosed acute outbreak of SLE, who experienced a life-threatening multisystem flare at 24 weeks of gestational age. This case represents one of the most extreme manifestations of lupus disease activity associated with pregnancy that has been reported in literature and emphasizes the importance of preconception evaluation and counseling and amultidisciplinary management approach in cases with a complex and evolving clinical course.
摘要系统性红斑狼疮是一种慢性炎症性自身免疫性疾病,在育龄女性中发病率较高。近年来,妊娠期SLE患者的预后明显改善。尽管治疗方案有所改善,但与健康女性相比,发作、先兆子痫、流产和早产的风险仍然很高。本文的目的是对妊娠期系统性红斑狼疮患者的当前治疗方案进行综述,并报告一例32岁的新诊断急性系统性红斑炎患者,该患者在胎龄24周时出现危及生命的多系统发作。该病例代表了文献中报道的与妊娠相关的狼疮疾病活动的最极端表现之一,并强调了在临床过程复杂且不断发展的病例中,成见评估、咨询和多学科管理方法的重要性。
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引用次数: 0
Basal Cell Carcinoma Arising within a Trichoepithelioma: An Immunohistochemical Study 毛上皮瘤内发生基底细胞癌:免疫组织化学研究
Pub Date : 2020-08-01 DOI: 10.2478/acm-2020-0008
V. Bartoš, Martin Biopsy
Abstract Background: Trichoepithelioma (TE) and basal cell carcinoma (BCC) of skin represent distinct tumor entities but they have a close histogenetic and phenotypic relationship. Objective: A unique case of a BCC arising within a TE is described with an emphasis on the analysis of different and for each tumor type typical immunophenotype. Material and Methods: A 71-year-old man presented with a subcutaneous solid tumor in the lumbar region. The resected tumor specimen was studied by immunohistochemistry. Results: Histology revealed a coexistence of classic TE and nodular BCC. Both tumors were strongly positive for BerEP4 and negative for EMA. Neoplastic epithelium of the BCC showed a diffuse staining for Bcl-2, while the TE expressed Bcl-2 almost exclusively in the peripheral cells of tumor islands. In the BCC, neoplastic nodules exhibited a focal staining for CD10, while the peritumorous stroma did not. In contrast, the TE showed a focal immunoreactivity for CD10 in the stromal cells around the neoplastic islands which were completely negative. The TE contained intratumorous CK20-labeled Merkel cells but they were not detected in the BCC. A stromal immunore-activity for CD34 was found in both tumors. Proliferative activity (Ki-67) was slightly higher in the BCC than in the TE. Conclusion: Although a concomitant presence of TE and BCC in the same skin lesion is a unique finding, it may be sometimes encountered in a biopsy practice. Pathologists should provide a careful histologic examination of the whole TE lesion with precise section sampling to unveil such possible association.
摘要背景:皮肤毛上皮瘤(TE)和基底细胞癌(BCC)是不同的肿瘤实体,但它们具有密切的组织遗传学和表型关系。目的:描述一例在TE内发生的BCC的独特病例,重点分析不同肿瘤类型和每种肿瘤类型的典型免疫表型。材料和方法:一位71岁的男性,在腰椎区域出现皮下实体瘤。采用免疫组织化学方法对切除的肿瘤标本进行研究。结果:组织学显示典型TE和结节性BCC共存。两种肿瘤均为BerEP4强阳性,EMA阴性。BCC的新生上皮显示Bcl-2的弥漫性染色,而TE几乎只在肿瘤岛的外周细胞中表达Bcl-2。在基底细胞癌中,肿瘤结节显示CD10的局灶性染色,而瘤周间质则没有。相反,TE在肿瘤岛周围的基质细胞中显示CD10的局灶性免疫反应性,完全阴性。TE含有肿瘤内CK20标记的Merkel细胞,但在BCC中未检测到。在两种肿瘤中都发现了CD34的基质免疫再活性。BCC的增殖活性(Ki-67)略高于TE。结论:尽管在同一皮肤病变中同时存在TE和BCC是一种独特的发现,但在活检实践中有时也会遇到这种情况。病理学家应通过精确的切片取样对整个TE病变进行仔细的组织学检查,以揭示这种可能的相关性。
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引用次数: 0
Ultrasound Elastography: Review of Techniques, Clinical Application, Technical Limitations, and Safety Considerations in Neonatology 超声弹性成像:技术综述,临床应用,技术限制和新生儿安全考虑
Pub Date : 2020-08-01 DOI: 10.2478/acm-2020-0009
F. Schrenk, P. Uhrík, Z. Uhrikova, Z. Uhrikova
Abstract Ultrasound elastography is a relatively new non-invasive diagnostic imaging technology that maps elastic properties and the stiffness of soft tissue. In general, these methods can be classified into strain imaging methods that use internal or external compression stimuli and a shear wave imaging that use ultrasound-generated travelling shear wave stimuli. In this review we describe the basics of ultrasound elastography, discuss differences between various ultrasound elastography techniques, and review advantages, limitations, and the safety of these techniques in clinical practice, especially in neonatology. Furthermore, we review the potential of application of elastography in revealing brain injury and characterizing age dependent differences in preterm and term infants.
摘要超声弹性成像是一种相对较新的非侵入性诊断成像技术,可绘制软组织的弹性特性和硬度。通常,这些方法可以分为使用内部或外部压缩刺激的应变成像方法和使用超声产生的行波剪切波刺激的剪切波成像方法。在这篇综述中,我们描述了超声弹性成像的基础,讨论了各种超声弹性成像技术之间的差异,并回顾了这些技术在临床实践中的优势、局限性和安全性,尤其是在新生儿科。此外,我们还回顾了弹性成像在揭示早产儿和足月儿脑损伤和表征年龄依赖性差异方面的应用潜力。
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引用次数: 3
Surgical Therapy of Esophagus Reflux Disease 食管反流病的外科治疗
Pub Date : 2020-08-01 DOI: 10.2478/acm-2020-0007
M. Smolár, I. Dedinská, A. Bobulova, M. Hošala, M. Adámik, M. Grajciar, J. Janik, L. Laca
Abstract Introduction: Fundoplication is the most frequently used action in the surgical treatment of gastroesophageal reflux disease (GERD). There are several types of fundoplication. The objective of our study was to identify complications after surgical treatment of GERD. Material and Methods: We determined several parameters of the monitored and we recorded complications related to surgery: occurrence of surgical, early and late post-surgical complications. Results: 52 patients (24 men and 28 women) with an average age of 53.3 years were included. The most frequently chosen type of fundoplication was Nissen-Rossetti. The most frequently occurring subjective post-surgery difficulties were temporal dysphagia (11.5%), sensation of nausea and vomiting after eating (3.8 %), pain in the surgical wound, and dyspnoea occurring in all patients after thoracotomy. Early post-surgery complication developed in 6 patients (11.5 %) Conclusion: Occurrence of complications in the group monitored by us was up to 11.5 % and perioperative mortality was 0 %. Hiatal hernia is frequently found in patients with GERD and it is considered to be one of the major causes for the development of this disease.
摘要简介:胃底折叠术是胃食管反流病(GERD)外科治疗中最常用的手术方式。胃底折叠有几种类型。我们研究的目的是确定GERD手术治疗后的并发症。材料和方法:我们确定了监测的几个参数,并记录了与手术相关的并发症:手术并发症的发生率、术后早期和晚期并发症。结果:纳入52例患者(男24例,女28例),平均年龄53.3岁。最常选择的胃底折叠术类型是Nissen-Rossetti。最常见的主观术后困难是颞叶吞咽困难(11.5%)、进食后恶心和呕吐感(3.8%)、手术伤口疼痛和开胸术后出现的呼吸困难。6例(11.5%)患者出现术后早期并发症。结论:我们监测的组并发症发生率高达11.5%,围手术期死亡率为0%。先天性胃食管反流病患者常见先天性疝,它被认为是该疾病发展的主要原因之一。
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引用次数: 0
Biofeedback – A Promising Non Pharmacological Tool of Stress – Related Disorders 生物反馈——一种治疗压力相关疾病的有前途的非药物工具
Pub Date : 2020-04-01 DOI: 10.2478/acm-2020-0001
M. Slavikova, N. Sekaninova, Olexova L. Bona, Z. Visnovcova, I. Tonhajzerova
Abstract Biofeedback is a therapeutic method of obtaining better awareness of physiological functions based on principles of operant conditioning and learning in general. While patient observes changes in physiological parameters in real-time (e.g. blood pressure, heart rate variability, temperature, electrodermal activity, etc.), he/she learns how to manipulate them at will. By means of this technique, individuals can improve their mental, emotional, and physical health. Clinical biofeedback training becomes popular for treating a variety of medical conditions, manage ment of disease symptoms, and improvement of overall health through training of stress management. There is no center or group to systematically deal with biofeedback methods in Slovakia, except the Slovak Institute of CBT (cognitive-behavioral therapy) that teaches biofeedback as a therapeutic method. However, biofeedback and its opportunities have a relatively long history of exploration and practice, which is the best precondition for positive changes in this area. The review article aims to provide an insight to biofeedback training as a non-pharmacological therapeutic tool in stress management and stress-related diseases and disorders. The article also describes biofeedback modalities and efficacy on various medical conditions.
摘要生物反馈是一种基于操作性条件反射和一般学习原理获得更好的生理功能意识的治疗方法。患者在实时观察生理参数变化(如血压、心率变异性、体温、皮电活动等)的同时,也学会了如何随意操纵这些参数。通过这种技术,个人可以改善他们的精神、情感和身体健康。临床生物反馈训练在治疗各种医疗状况、管理疾病症状和通过压力管理培训改善整体健康方面变得流行。除了斯洛伐克认知行为疗法研究所(CBT)将生物反馈作为一种治疗方法进行教学外,斯洛伐克没有系统地处理生物反馈方法的中心或团体。然而,生物反馈及其机遇有着相对较长的探索和实践历史,这是该领域积极变化的最佳先决条件。这篇综述文章旨在提供生物反馈训练作为压力管理和压力相关疾病和障碍的非药物治疗工具的见解。文章还描述了生物反馈的方式和功效在各种医疗条件。
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引用次数: 3
New Approaches to Diagnostics of C.Difficile Infection 诊断困难梭菌感染的新方法
Pub Date : 2020-04-01 DOI: 10.2478/acm-2020-0003
Z. Štofková, E. Nováková, V. Sadloňová
Abstract Introduction: Clostridium difficile infection (CDI) is the most common infectious cause of diarrhoea in hospitalised patients. It is a severe issue with increasing incidence in healtcare facilities and commmunities. Early and appropriate testing of CDI is very imortant. There are many different approaches that can be used in the CDI laboratory diagnostics. Recently performed studies evaluated diagnostic algorithms to optimize laboratory CDI diagnostics. The aim of the work was to implement an optimal algorithm of testing methods in CDI diagnostics. Materials and methods: The retrospective analysis of patients’ samples suspected on CDI was carried out in 2017. The data was analysed from the Laboratory Klinicka Biochemia in Zilina. The application of ESCMID re -commendation criteria for algorithm of testing, together with procedures in laboratory practice was carried out. Results: The analysis of the data showed that the applied algorithm or testing in CDI and highlighted the importance of preanalytic phase, and the evaluation of testing methods and results, together with clinical findings. Two- and three- step algorithm together with cultivation methods were applied. 87,6% of samples could be eva -luated with positive or negative results according to the 2-step algorhitm. Further samples were assessed and tested by ELISA test or PCR method. Conclusion: CDI represents a significant burden in healthcare facilities. An early diagnostics and interpretation helps to start the early treatment and helps in surveillence of the infection.
摘要简介:艰难梭菌感染(CDI)是住院患者腹泻最常见的感染原因。这是一个严重的问题,医疗机构和社区的发病率越来越高。CDI的早期和适当的测试是非常重要的。有许多不同的方法可以用于CDI实验室诊断。最近进行的研究评估了优化实验室CDI诊断的诊断算法。这项工作的目的是实现CDI诊断中测试方法的优化算法。材料和方法:2017年对疑似CDI的患者样本进行回顾性分析。数据来自Zilina的Klinika生物化学实验室。将ESCMID重新推荐标准应用于测试算法,并在实验室实践中进行了应用。结果:数据分析表明,该算法或测试在CDI中的应用,并强调了预分析阶段的重要性,以及测试方法和结果的评估,以及临床发现。采用两步和三步算法以及培养方法。根据两步算法,87,6%的样本可以评估为阳性或阴性结果。进一步的样品通过ELISA测试或PCR方法进行评估和测试。结论:CDI是医疗机构的一大负担。早期诊断和解释有助于开始早期治疗,并有助于监测感染。
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引用次数: 1
Brachial Plexopathy as an Unusual First Sign of a Head and Neck Cancer: Case Report 臂丛病是癌症头颈部的一种罕见的首发症状:病例报告
Pub Date : 2020-04-01 DOI: 10.2478/acm-2020-0005
V. Surova, P. Slávik, V. Calkovsky, A. Hajtman
Abstract Malignancies in the ENT (Ear, Nose, and Throat) area are mostly manifested by dysphagia, dysphonia, dyspnea, throat swelling, and other “traditional” head and neck symptoms. Sporadically, a primary tumor or metastasis can reach such a size and it can be localized in such an area in which it can cause the pathology of the brachial plexus. If this appears first, differential diagnosis may be more difficult. In this article the authors review current literature knowledge and present the case of this unusual sign of a head and neck cancer at the Clinic of Otorhinolaryngology and Head and Neck Surgery, Jessenius Faculty of Medicine, Comenius University, and Martin University Hospital, Martin, Slovakia.
摘要耳鼻咽喉部的恶性肿瘤主要表现为吞咽困难、吞咽困难、呼吸困难、喉咙肿胀和其他“传统”头颈部症状。原发性肿瘤或转移灶可以达到这样的大小,并且可以定位在这样一个区域,在该区域可以引起臂丛神经的病理学。如果这种情况首先出现,鉴别诊断可能会更加困难。在这篇文章中,作者回顾了目前的文献知识,并在科梅纽斯大学Jessenius医学院耳鼻喉科和头颈外科诊所以及斯洛伐克马丁大学医院介绍了这种头颈部癌症的异常体征。
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引用次数: 0
Assessment of the Safety Climate at University Hospitals in the Slovak Republic from the Nurses’ Perspective 从护士的角度评价斯洛伐克共和国大学医院的安全气候
Pub Date : 2020-04-01 DOI: 10.2478/acm-2020-0004
D. Kalánková, D. Bartoníčková, K. Žiaková, E. Gurková, Radka Kurucová
Abstract Introduction: Safety climate consists of individual dimensions that might be assessed using specific instruments, e.g., the Hospital Survey on Patient Safety Culture (HSOPS). Establishing the safety climate in healthcare facilities leads to improvements in patient safety. Aim: To assess the safety climate at university hospitals in the Slovak Republic from the nurses’ perspective and to determine the relationship between organisational variables and the particular components of the safety climate. Methods: The study has a cross-sectional design. Data were collected using the HSOPS between December 2017 and July 2018. Two university hospitals participated in the study and overall 280 respondents were included. Respondents were recruited through the purposive sampling method. Data were analysed by descriptive and inductive statistics in the statistical programme SPSS 25.0. Results: Results indicate that in the university hospitals there is a low-level of safety climate. The significant relationship was proved between organisational variables such as the experience in the current position, leaving intention, overtime, perception of staff adequacy, unit type, nurse-patient ratio, and the particular components of the safety climate. Conclusion: Our findings may help hospital management to raise the awareness of the safety climate and to gain a sophisticated overview of the particular components of the safety climate. Adding new organisational variables may help to assess the safety climate from multiple perspectives and, thus, identify areas contributing to patient safety.
摘要简介:安全氛围由个体维度组成,可以使用特定的工具进行评估,例如医院患者安全文化调查(HSOPS)。在医疗机构中建立安全环境有助于改善患者安全。目的:从护士的角度评估斯洛伐克共和国大学医院的安全环境,并确定组织变量与安全环境特定组成部分之间的关系。方法:本研究采用横断面设计。数据是在2017年12月至2018年7月期间使用HSOPS收集的。两所大学医院参与了这项研究,共有280名受访者参与其中。受访者是通过有目的的抽样方法招募的。数据采用SPSS 25.0统计软件中的描述性和归纳统计学进行分析。结果:结果表明,高校医院存在着低水平的安全氛围。组织变量之间的显著关系已被证明,如当前职位的经验、离职意向、加班、对员工充足性的看法、单位类型、护患比例和安全环境的特定组成部分。结论:我们的研究结果可能有助于医院管理层提高对安全环境的认识,并对安全环境中的特定组成部分进行全面了解。添加新的组织变量可能有助于从多个角度评估安全环境,从而确定有助于患者安全的领域。
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引用次数: 2
Bronchial Asthma: Current Trends in Treatment 支气管哮喘:当前治疗趋势
Pub Date : 2020-04-01 DOI: 10.2478/acm-2020-0002
R. Paľová, J. Adamcakova, D. Mokra, J. Mokrý
Abstract Asthma is a heterogenous disease which pathophysiology is still poorly understood. Asthma was traditionally divided into allergic (extrinsic) and non-allergic (intrinsic) types, while patients with allergic type responded better to corticosteroids. Since 2013 the definition of asthma has changed. Recently, better insight into clinical consi -derations and underlying inflammatory phenotypes has been gained. Defining these phenotypes has already led to more specific clinical trials and, therefore, to more personalized and successfully targeted therapy. For future, much more effort is put in identifying new phenotype-specific biomarkers which could be helpful in stratification of heterogeneous patients with asthma.
哮喘是一种异质性疾病,其病理生理机制尚不清楚。哮喘传统上分为过敏性(外源性)和非过敏性(内在)类型,而过敏性类型的患者对皮质类固醇反应更好。自2013年以来,哮喘的定义发生了变化。最近,对临床考虑和潜在的炎症表型有了更好的了解。定义这些表型已经导致了更具体的临床试验,因此,更个性化和成功的靶向治疗。未来,更多的努力将放在鉴定新的表型特异性生物标志物上,这可能有助于对异质性哮喘患者进行分层。
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引用次数: 2
The Importance of Using SOX10 for Exact Diagnosis of Desmoplastic Melanoma SOX10在Desmoplastic黑色素瘤精确诊断中的重要性
Pub Date : 2019-12-01 DOI: 10.2478/acm-2019-0015
K. Adamicová, Ž. Fetisovová, M. Bobrovská, I. Homola
Abstract Desmoplastic malignant melanoma is a rare variant of spindle cell melanoma commonly seen in older adults on sun-exposed areas. It accounts for 1–4 % of all cases of cutaneous melanoma. The common location of the desmoplastic melanoma is the head and neck region, whereasother sites are less common. A 45-year-old male presented with an proliferative growth on nose, after a trauma that was diagnosed as tumor. Histopathological examination with the help of wide panel of immunohistochemical methods and with emphasis on SOX10, was, after a broad diferential diagnosis concluded as a desmoplastic melanoma.
摘要:结缔组织增生性恶性黑色素瘤是一种罕见的梭形细胞黑色素瘤,常见于阳光照射区域的老年人。它占所有皮肤黑色素瘤病例的1 - 4%。结缔组织增生黑色素瘤的常见部位是头颈部,而其他部位则不常见。45岁男性,鼻外伤诊断为肿瘤后,鼻部出现增生性生长。在广泛的免疫组织化学方法的帮助下,组织病理学检查,重点是SOX10,在广泛的鉴别诊断后,结论是结缔组织增生黑色素瘤。
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引用次数: 1
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Acta Medica Martiniana
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