Acta Medica Croatica最新文献

Paget-Schroetter syndrome is a relatively uncommon condition related to primary thrombosis of the axillary/subclavianvein at the costoclavicular junction. Vibration injury is an unusual cause of this syndrome. We report on a 28-year-old manwho presented with acute onset left arm swelling after whole-day work with a pneumatic drill. Duplex ultrasound confirmedthe presence of a thrombus in his left axillary and subclavian vein, which was treated with low molecular weight heparin,eventually switched to oral anticoagulation.

Effective physical, chemical, biochemical and immune function of the skin requires a corresponding structure of theepidermis. Filaggrin, one of epidermal proteins, is essential for the formation of corneocytes and intracellular metabolites,which in turn contribute to maintaining the stratum corneum humidity and acidic pH of the skin surface. However, a numberof profilaggrin gene mutations have been described, as well as different inflammatory conditions and different externalfactors that all resulted in filaggrin deficiency. Filaggrin deficiency is recorded in different skin diseases and discoveriesrelated to metabolic processing of filaggrin point to new goals in therapeutic strategies. In this preview, the main propertiesof the formation and metabolism of filaggrin are described, as well as clinical implications of filaggrin deficiency in theetiopathogenesis of some skin diseases.

Patients with amyotrophic lateral sclerosis require comprehensive care with a multidisciplinary approach, which isindividually adjusted to each patient. The goals of neurorehabilitation should be adjusted to the stage of disease. In earlystages, physical therapy is focused on preserving and optimizing motor and respiratory function. At this stage, familyshould be involved to partake in desired activities and be informed regarding the natural course of the disease. In latestages, physical therapy is focused on preventing respiratory complications and contractures, and orthotics may also berecommended. The onset of dysarthria should trigger swallowing and pulmonary function testing. Swallowing maneuversshould be tried at the onset of symptoms, later feeding tubes or percutaneous gastrostomy tube is necessary. Noninvasivemechanical ventilation may delay the need of tracheostomy and invasive mechanical ventilation. The key objectives ofmultidisciplinary teams are to optimize medical care, facilitate communication, and thus to improve the quality of care andquality of life.

Over the last 30 years, medical expenditure has increased throughout the world. The main reasons estimated to laybehind it include aging, ever more chronic diseases and new emerging diseases, new drugs, expanded indications ofcurrent drugs, and development of pharmaceutical industry. A challenge for healthcare professionals is to sustain currentquality of care and enable medical innovations while attempting to contain costs. The overall goal is to demonstrate thepharmacoeconomic value, i.e. a balance of economic, humanistic and clinical outcomes.

Anaplastic carcinoma of thyroid gland is one of the four most malignant tumors in humans. It appears in one or two patientsper million per year. It is very rare in children. A 17-year-old female patient was admitted to the Clinical Department of ENTand Head and Neck Surgery, Split University Hospital Center, for thyroid gland surgery due to rapid growth of a node in thethyroid gland left lobe. Preoperative examination indicated benign nature of changes. Total thyroidectomy with levels VIand VII neck dissection was done. Intraoperative slide of the left lobe was malignant. Positron emission tomography andcomputed tomography were also done. The finding was negative. The patient was examined by an ENT-oncology team andjuvenile radiotherapy was administered. It was found to be carcinoma stage IVa according to TNM classification. One yearafter the operation, the patient was well and had no signs of illness. This case report is a contribution to the existing butscarce knowledge of anaplastic carcinoma of thyroid gland in young patients in the world.

Application of supportive wound dressing is an important segment for successful result of modern treatment of chronic ulcers. The right choice of dressing is the key to faster, better, and ultimately more cost-effective treatment outcome. Due to the extremely large number of generic types and variants, the main element for proper dressing selection is to know the mechanisms of action and clinical evidence of the effectiveness because of many local factors that delay ulcer healing. The advent of wound dressing that is efficient at the three clinically identified key local factors that largely impede the healing of ulcers, i.e. exudate, infection and biofilm, has made a significant step forward in the creation of optimal conditions for faster healing of chronic ulcers. The complexity of the effects of new technologies, which integrate hidrofiber technology and Ag + technology, provides effective antimicrobial control while at the same time preventing biofilm reformation.

Wound represents a disruption of anathomic and physiologic continuity of the skin. Regarding to the healing process, wounds can be classified as acute or chronic wounds. Quality of life is primarily concerned with the impact of chronic wounds. A wound is considered chronic if healing does not occur within expected period of time regarding to its etiology and localization. Chronic wounds can be classified as typical and atypical. The majority of wounds (95 percent) are typical ones which include ischaemic, neurotrophic and hypostatic ulcer and two separate entities: diabetic foot and decubital ulcers. An 80 percent of chronic wounds localized on lower leg are result of chronic venous insufficiency, in 5-10 percent cause is of arterial etiology, whereas the remainder is mostly neuropathic ulcer. Chronic wounds represent a significant burden to patients, health care professionals and the entire health care system. Chronic wounds affect the elderly population and it is estimated that 1-2 percent of western population suffer from it. This estimate is expected to rise due to an increasing population of the elderly and the diabetic and obesity epidemic. The WHO definition of health is "A state of complite physical, mental and social well-being and not merely the absence of disease or infirmity". Based on this definition, quality of life in relation to health may be defined as "the functional effect of an illness and it's consequent therapy upon a patient, as perceived by the patient". The domains that contribute to this effect are physical, psychological and social functioning. The patient's own perceptions of an illness were found to play an important role in explainig quality of life. Chronic wounds significantly decrease the quality of life in a number of ways such as reduced mobility, pain, unpleasant odor, sleep disturbances, social isolation and frustration, and inability to perform everyday duties. Among the most common psychological reactions to chronic diseases, including chronic wounds, are depression, anxiety, aggression and frustration. Psychological factors may not only be a consequence of delayed healing, but may also impact on wound healing. Anxiety and depression have direct influences on endocrine and immune function. About the impact of disease on quality of life and individuals' perceptions of illness, there are questionnaires and methods to analyze this, but the challenge is to move from a focus on wound management to understanding the specific needs of each individual within the context of their life.

Lower leg ulcer is the most common form of ulceration of lower extremities. The prevalence of leg ulcer varies among studies from 0.1% to 0.6%. During the last decade, new concepts on the inflammatory phase in chronic ulcer have been discovered, such as the importance of metalloproteinases, growth factor, irregular muscular function, vascular insufficiency and presence of biofilm in the ulcer that prevents healing. There are several hypotheses to explain the pathophysiological steps, referring to popliteal venous hypertension. Currently, the treatment of leg ulcer relies on due knowledge of ulcer pathophysiology and making an accurate diagnosis. Today, modern supportive dressings improve the patient's quality of life; however, their targeted application according to the protocol and indications is required. A new method of efficient wound biofim exclusion today is the application of hydrofiber dressings containing a combination of silver ions and two disinfectants because they influence the exclusion and prevention of new biofilm formation in the ulcer.

The skin microbiome is the aggregate of microorganisms that reside on the surface and in deep layers of the skin. Skin is colonized by bacteria, fungi, viruses and mites, maintaining a balance. Disruption in the ecosystem results in skin infections. Chronic wounds in diabetics, elderly and immobile individuals are at risk of skin organisms to invade and become pathogenic upon breach of the skin barrier. The bacteria of the skin microbiome may contribute to delayed healing and persistent inflammation. Staphylococcus epidermidis is an invasive skin organism that causes infection, i.e. hospital acquired infection (HAl) on medical devices and form biofilm. At the most basic level, biofilm can be described as bacteria embedded in a thick, slimy barrier of sugars and proteins. The biofilm barrier protects the microorganisms from external threats. Biofilms provide a reservoir of potentially infectious microorganisms that are resistant to antimicrobial agents, and their importance in the failure of medical devices and chronic inflammatory condition is increasingly being recognized. Particular research interest exists in the association of biofilms with wound infection and non-healing, i.e. chronic wounds. There is now strong evidence that biofilm is present in the majority of chronic wounds. Specialized microscopic techniques used since 2008 have allowed several research groups to demonstrate that 60% to 90% of chronic wounds have biofilm versus only 6% of acute wounds. While many studies confirm that chronic wounds often contain a polymicrobial flora, controversy remains with regard to whether these organisms directly contribute to non-healing. It seems most likely that individual bacteria themselves are not directly responsible for non-healing wounds. Rather, there is direct correlation between the presence of four or more distinct bacterial species in a wound and non-healing, suggesting that mixed microbial populations are the cause of pathology. The most reliable method to confirm the presence of a biofilm is specialized microscopy, e.g., bright-field, fluorescence in situ hybridization (FISH), and environmental scanning electron microscope (ESEM). Surface wound cultures underestimate total wound microbiota--misleading. Histological staining of deep debrided tissue shows evidence of biofilms. Now it is recognized that the majority of microbial species in chronic wounds are anaerobic bacteria (deep swabbing techniques yield similar findings to biopsies) if samples are processed within two hours. Traditional (wound culture method) cultures have limitations because all microbes (the organisms within the biofilm) cannot be isolated in culture or cannot be detected. Therefore, the most effective methods are molecular