Pub Date : 2016-02-20DOI: 10.6016/SLOVMEDJOUR.V85I1.1464
K. Geršak, Z. Fras, M. Rems
Clinical guideline is systematically developed set of statements and assist a doctor, other health care practitioners and patients to make decisions about appropriate health care for specific clinical circumstances. They are produced under the auspices of medical specialty associations, relevant professional societies and organizations. The guidelines are developed by standards; they are based on a systematic review of the scientific evidence, statements are explicitly linked to the supporting evidence and graded according to the strength of that evidence.
{"title":"Do we know what makes a good clinical guideline","authors":"K. Geršak, Z. Fras, M. Rems","doi":"10.6016/SLOVMEDJOUR.V85I1.1464","DOIUrl":"https://doi.org/10.6016/SLOVMEDJOUR.V85I1.1464","url":null,"abstract":"Clinical guideline is systematically developed set of statements and assist a doctor, other health care practitioners and patients to make decisions about appropriate health care for specific clinical circumstances. They are produced under the auspices of medical specialty associations, relevant professional societies and organizations. The guidelines are developed by standards; they are based on a systematic review of the scientific evidence, statements are explicitly linked to the supporting evidence and graded according to the strength of that evidence.","PeriodicalId":49350,"journal":{"name":"Zdravniski Vestnik-Slovenian Medical Journal","volume":"16 3","pages":"6-14"},"PeriodicalIF":0.0,"publicationDate":"2016-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72606302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Blazina, G. Markelj, M. Debeljak, A. Jeverica, N. Toplak, Nevenka Bratanič, M. Pokorn, P. Kopač, A. Pečnik, M. Košnik, J. Jazbec, M. Kuhar, A. Ihan, T. Avčin
Data from Slovene national primary immunodeficiency (PID) registry are presented. Besides clinical and genetic data of patients with PID, quality indicators in patient care are included. Data are systematically collected in Department of Allergology, Rheumatology and Clinical Immunology in collaboration with physicians of different specialities. Increasing number and spectrum of PID are recognised in Slovenia. After establishment of Slovene multidisciplinary group in PID care in 2007 thorough immunological and genetic diagnostics, subcutaneous immunoglobulin replacement and treatment of PID with haematopoietic stem cell transplantation were introduced in routine clinical practice in Slovenia. Increased medium age of PID patients reflects improved survival and better recognition of PID in adults. According to the data in comparable registries percentages of patients with predominantly antibody deficiencies and complement deficiencies are low and high, respectively.
{"title":"Slovene national registry of patients with primary immunodeficiency.","authors":"S. Blazina, G. Markelj, M. Debeljak, A. Jeverica, N. Toplak, Nevenka Bratanič, M. Pokorn, P. Kopač, A. Pečnik, M. Košnik, J. Jazbec, M. Kuhar, A. Ihan, T. Avčin","doi":"10.6016/ZDRAVVESTN.1321","DOIUrl":"https://doi.org/10.6016/ZDRAVVESTN.1321","url":null,"abstract":"Data from Slovene national primary immunodeficiency (PID) registry are presented. Besides clinical and genetic data of patients with PID, quality indicators in patient care are included. Data are systematically collected in Department of Allergology, Rheumatology and Clinical Immunology in collaboration with physicians of different specialities. Increasing number and spectrum of PID are recognised in Slovenia. After establishment of Slovene multidisciplinary group in PID care in 2007 thorough immunological and genetic diagnostics, subcutaneous immunoglobulin replacement and treatment of PID with haematopoietic stem cell transplantation were introduced in routine clinical practice in Slovenia. Increased medium age of PID patients reflects improved survival and better recognition of PID in adults. According to the data in comparable registries percentages of patients with predominantly antibody deficiencies and complement deficiencies are low and high, respectively.","PeriodicalId":49350,"journal":{"name":"Zdravniski Vestnik-Slovenian Medical Journal","volume":"1 1","pages":"797-808"},"PeriodicalIF":0.0,"publicationDate":"2016-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83117408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Venous thromboembolism (deep vein thrombosis, pulmonary embolism) are serious, but highly preventable complications associated with gynecologic surgery. Risk of thromboembolic complications depends on patient characteristics, type and duration of surgery. Beside adequate hydration, according to the risk stratification we recommend thromboprophlaxis with mechanical methods and antithrombotic drugs (usually low molecular weight heparins). In this article current guidelines for effective and safe thromboprophl axis for gynecological surgery are presented .
{"title":"PREVENTION OF VENOUS THROMBOEMBOLISM IN GYNECOLOGIC SURGERY","authors":"M. Pakiz, T. Bizjak, N. Vene, B. Bizjak","doi":"10.6016/ZDRAVVESTN.1268","DOIUrl":"https://doi.org/10.6016/ZDRAVVESTN.1268","url":null,"abstract":"Venous thromboembolism (deep vein thrombosis, pulmonary embolism) are serious, but highly preventable complications associated with gynecologic surgery. Risk of thromboembolic complications depends on patient characteristics, type and duration of surgery. Beside adequate hydration, according to the risk stratification we recommend thromboprophlaxis with mechanical methods and antithrombotic drugs (usually low molecular weight heparins). In this article current guidelines for effective and safe thromboprophl axis for gynecological surgery are presented .","PeriodicalId":49350,"journal":{"name":"Zdravniski Vestnik-Slovenian Medical Journal","volume":"41 1","pages":"734-742"},"PeriodicalIF":0.0,"publicationDate":"2015-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79216428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-12-14DOI: 10.6016/SLOVMEDJOUR.V84I11.1390
D. Strah, P. Ovniček, J. Bernik
Background: Chorionic villus sampling and amniocentesis as definitive diagnostic procedures represent a gold standard for prenatal diagnosis of chromosomal abnormalities. The methods are invasive and lead to a miscarriage and fetal loss in approximately 0.5–1 %. Non-invasive prenatal DNA testing (NIPT) is based on the analysis of cell-free fetal DNA from maternal blood. It represents a highly accurate screening test for detecting the most common fetal chromosomal abnormalities. In our study we present the results of NIPT testing in the Diagnostic Center Strah, Slovenia, over the last 3 years. Methods: In our study, 123 pregnant women from 11th to 18th week of pregnancy were included. All of them had First trimester assessment of risk for trisomy 21, done before NIPT testing. Results: 5 of total 6 high-risk NIPT cases (including 3 cases of Down syndrome and 2 cases of Klinefelter’s syndrome) were confirmed by fetal karyotyping. One case–Edwards syndrome was false positive. Patau syndrome, triple X syndrome or Turner syndrome were not observed in any of the cases. Furthermore, there were no false negative cases reported. In general, NIPT testing had 100 % sensitivity (95 % confidence interval: 46.29 %–100.00 %) and 98.95 % specificity (95 % confidence interval: 93.44 %–99.95 %). In determining Down syndrome alone, specificity (95 % confidence interval: 95.25 %- 100.00 %) and sensitivity (95 % confidence interval: 31.00 %–100.00 %) turned out to be 100 %. In 2015, the average turnaround time for analysis was 8.3 days from the day when the sample was taken. Repeated blood sampling was required in 2 cases (redraw rate = 1.6 %). Conclusions: Our results confirm that NIPT represents a fast, safe and highly accurate advanced screening test for most common chromosomal abnormalities. In current clinical practice, NIPT would significantly decrease the number of unnecessary invasive procedures and the rate of fetal loss caused by invasive diagnostics.
{"title":"Non-invasive prenatal cell-free fetal DNA testing for down syndrome and other chromosomal abnormalities","authors":"D. Strah, P. Ovniček, J. Bernik","doi":"10.6016/SLOVMEDJOUR.V84I11.1390","DOIUrl":"https://doi.org/10.6016/SLOVMEDJOUR.V84I11.1390","url":null,"abstract":"Background: Chorionic villus sampling and amniocentesis as definitive diagnostic procedures represent a gold standard for prenatal diagnosis of chromosomal abnormalities. The methods are invasive and lead to a miscarriage and fetal loss in approximately 0.5–1 %. Non-invasive prenatal DNA testing (NIPT) is based on the analysis of cell-free fetal DNA from maternal blood. It represents a highly accurate screening test for detecting the most common fetal chromosomal abnormalities. In our study we present the results of NIPT testing in the Diagnostic Center Strah, Slovenia, over the last 3 years. Methods: In our study, 123 pregnant women from 11th to 18th week of pregnancy were included. All of them had First trimester assessment of risk for trisomy 21, done before NIPT testing. Results: 5 of total 6 high-risk NIPT cases (including 3 cases of Down syndrome and 2 cases of Klinefelter’s syndrome) were confirmed by fetal karyotyping. One case–Edwards syndrome was false positive. Patau syndrome, triple X syndrome or Turner syndrome were not observed in any of the cases. Furthermore, there were no false negative cases reported. In general, NIPT testing had 100 % sensitivity (95 % confidence interval: 46.29 %–100.00 %) and 98.95 % specificity (95 % confidence interval: 93.44 %–99.95 %). In determining Down syndrome alone, specificity (95 % confidence interval: 95.25 %- 100.00 %) and sensitivity (95 % confidence interval: 31.00 %–100.00 %) turned out to be 100 %. In 2015, the average turnaround time for analysis was 8.3 days from the day when the sample was taken. Repeated blood sampling was required in 2 cases (redraw rate = 1.6 %). Conclusions: Our results confirm that NIPT represents a fast, safe and highly accurate advanced screening test for most common chromosomal abnormalities. In current clinical practice, NIPT would significantly decrease the number of unnecessary invasive procedures and the rate of fetal loss caused by invasive diagnostics.","PeriodicalId":49350,"journal":{"name":"Zdravniski Vestnik-Slovenian Medical Journal","volume":"62 1","pages":"727-733"},"PeriodicalIF":0.0,"publicationDate":"2015-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90346827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Pavlič, Maja Sever, Z. Klemenc-Ketiš, I. Švab, J. Kersnik, W. Boerma
Background: Family practice in Slovenia is provided by state-employed family physicians as well as concessionaires . However, both work under a contract with the National Health Insurance Institute . This study focuses on comparing patients’ experiences with Slovenian concessionaires and state- employed physicians . Methods: We performed analyses using survey data from a cross-sectional study on patient experiences, which took place from September 2011 to April 2012 as a part of the international QUALICOPC study. The Slovenian branch of this study included 1,962 patients visiting family practices. Patients were classified into two groups regarding the registered status of their family physician. They completed the questionnaires immediately after visiting their family physicians. Data used in the analyses included 76 variables: 18 socio- economic and 58 variables linked to the patient's experience. Results: The analyses showed few differences between concessionaires and state-employed family physicians. I n comparison to patients of state-employed family physicians, patients of concessionaires were less likely to make an appointment for a visit (19.8% vs. 29.2%), were generally more frequent visitors (43.7% vs. 50.7%), and more often felt that opening hours are too restricted (25.7 % vs. 31.9%). Patients of concessionaires believed more often that in general, doctors can be trusted (40.1% vs.47.1 %). A smaller percentage of patients of concessionaires felt that their physician had the capacity to deal with personal problems as well as provide medical care (61.9% vs. 54.7%). Conclusions: There are few differences in patients’ experiences of state -employed family physicians and concessionaires. Slovenian patients have a generally positive experience with family practice services regardless of the family physicians ’ status. Plans for organizational change of the health sector should include patients’ perceptions of services.
{"title":"Do the experiences of patients of state-employed family physicians and concessionaires in Slovenia differ?","authors":"D. Pavlič, Maja Sever, Z. Klemenc-Ketiš, I. Švab, J. Kersnik, W. Boerma","doi":"10.6016/ZDRAVVESTN.1108","DOIUrl":"https://doi.org/10.6016/ZDRAVVESTN.1108","url":null,"abstract":"Background: Family practice in Slovenia is provided by state-employed family physicians as well as concessionaires . However, both work under a contract with the National Health Insurance Institute . This study focuses on comparing patients’ experiences with Slovenian concessionaires and state- employed physicians . Methods: We performed analyses using survey data from a cross-sectional study on patient experiences, which took place from September 2011 to April 2012 as a part of the international QUALICOPC study. The Slovenian branch of this study included 1,962 patients visiting family practices. Patients were classified into two groups regarding the registered status of their family physician. They completed the questionnaires immediately after visiting their family physicians. Data used in the analyses included 76 variables: 18 socio- economic and 58 variables linked to the patient's experience. Results: The analyses showed few differences between concessionaires and state-employed family physicians. I n comparison to patients of state-employed family physicians, patients of concessionaires were less likely to make an appointment for a visit (19.8% vs. 29.2%), were generally more frequent visitors (43.7% vs. 50.7%), and more often felt that opening hours are too restricted (25.7 % vs. 31.9%). Patients of concessionaires believed more often that in general, doctors can be trusted (40.1% vs.47.1 %). A smaller percentage of patients of concessionaires felt that their physician had the capacity to deal with personal problems as well as provide medical care (61.9% vs. 54.7%). Conclusions: There are few differences in patients’ experiences of state -employed family physicians and concessionaires. Slovenian patients have a generally positive experience with family practice services regardless of the family physicians ’ status. Plans for organizational change of the health sector should include patients’ perceptions of services.","PeriodicalId":49350,"journal":{"name":"Zdravniski Vestnik-Slovenian Medical Journal","volume":"6 1","pages":"670-678"},"PeriodicalIF":0.0,"publicationDate":"2015-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84856702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-10-06DOI: 10.6016/SLOVMEDJOUR.V84I9.1275
Katarina Vrabec, M. Ravnik-Glavač
Amyotrophic lateral sclerosis (ALS) is a rare complex neurodegenerative disease characterized by degeneration of motor neurons in the cerebral cortex, brainstem and spinal cord. The disease mainly occurs in adults, typically between 50. and 60. years and presents with symptoms like muscular weakness, atrophy and later on paralysis which lead to death due to respiratory failure within 2-5 years from onset and remains incurable. The symptoms typically start in the muscles of arms or legs (spinal onset) or bulbary (bulbar onset). Most ALS cases are sporadic although about 5% are familiar. Genetic factors contribute to the disease in sporadic form as well as in familial form. Mutations have been found in 116 genes among which SOD1 , TARDBP , FUS and C9ORF72 are represented in highest frequencies. Besides those four genes we are also describing 13 other genes involved in the disease process. Oligogenic model has been proposed for ALS that considers mutations in two or more genes in one patient. We emphasize the convergence between hereditary and sporadic form, which are clinically inseparable, and other neurodegenerative diseases that share with ALS genetic and clinical characteristics. Because about 2/3 of familial cases and only about 11% of sporadic cases are explained by mutations the research have been aimed at discovering new candidate genes using genome –wide association studies and at the epigenetic causes of the disease. We have recently completed the first representative genetic analysis of patients with ALS in Slovenia and research on methylation and microRNAs is currently in progress.
{"title":"GENETIC FACTORS ASSOCIATED WITH AMYOTROPHIC LATERAL SCLEROSIS","authors":"Katarina Vrabec, M. Ravnik-Glavač","doi":"10.6016/SLOVMEDJOUR.V84I9.1275","DOIUrl":"https://doi.org/10.6016/SLOVMEDJOUR.V84I9.1275","url":null,"abstract":"Amyotrophic lateral sclerosis (ALS) is a rare complex neurodegenerative disease characterized by degeneration of motor neurons in the cerebral cortex, brainstem and spinal cord. The disease mainly occurs in adults, typically between 50. and 60. years and presents with symptoms like muscular weakness, atrophy and later on paralysis which lead to death due to respiratory failure within 2-5 years from onset and remains incurable. The symptoms typically start in the muscles of arms or legs (spinal onset) or bulbary (bulbar onset). Most ALS cases are sporadic although about 5% are familiar. Genetic factors contribute to the disease in sporadic form as well as in familial form. Mutations have been found in 116 genes among which SOD1 , TARDBP , FUS and C9ORF72 are represented in highest frequencies. Besides those four genes we are also describing 13 other genes involved in the disease process. Oligogenic model has been proposed for ALS that considers mutations in two or more genes in one patient. We emphasize the convergence between hereditary and sporadic form, which are clinically inseparable, and other neurodegenerative diseases that share with ALS genetic and clinical characteristics. Because about 2/3 of familial cases and only about 11% of sporadic cases are explained by mutations the research have been aimed at discovering new candidate genes using genome –wide association studies and at the epigenetic causes of the disease. We have recently completed the first representative genetic analysis of patients with ALS in Slovenia and research on methylation and microRNAs is currently in progress.","PeriodicalId":49350,"journal":{"name":"Zdravniski Vestnik-Slovenian Medical Journal","volume":"34 1","pages":"617-627"},"PeriodicalIF":0.0,"publicationDate":"2015-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82442793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-10-06DOI: 10.6016/SLOVMEDJOUR.V84I9.1287
G. Vidali, S. Zver, H. Podgornik
Complete blood count is basic investigation in medicine. It gives us necessary information for acutely sick patient's diagnostic and treatment. We describe the most frequent etiology of red, white and thrombocyte cell lines abnormalities and give notice on conditions who require immediate measures. We had analyzed 1297 complete blood count results of patients who sought medical help in Emergency setting of Ljubljana's health care center from 1.1. 2014 to 31.1. 2014. Every fourth patient treated in the emergency setting had abnormalities in complete blood count. The most frequent finding was leucocytosis, following normocyte anemia and erytrocite's morphological abnormalities without laboratory signs of anemia. Every tenth patient had abnormalities in two or three cell lines. Complete blood count is probably the most basic investigation in medicine. From the results we can suspect on many different pathologies. Differential blood count should be ordered if we find abnormalities in complete blood count. Physicians should read and evaluate complete blood count with the same dedication as we read electrocardiogram.
{"title":"OVERVIEW OF THE MOST FREQUENT ABNORMALITIES IN THE COMPLETE BLOOD COUNT RESULTS IN EMERGENCY SETTING AND RECOGNITION OF EMERGENCY CONDITIONS","authors":"G. Vidali, S. Zver, H. Podgornik","doi":"10.6016/SLOVMEDJOUR.V84I9.1287","DOIUrl":"https://doi.org/10.6016/SLOVMEDJOUR.V84I9.1287","url":null,"abstract":"Complete blood count is basic investigation in medicine. It gives us necessary information for acutely sick patient's diagnostic and treatment. We describe the most frequent etiology of red, white and thrombocyte cell lines abnormalities and give notice on conditions who require immediate measures. We had analyzed 1297 complete blood count results of patients who sought medical help in Emergency setting of Ljubljana's health care center from 1.1. 2014 to 31.1. 2014. Every fourth patient treated in the emergency setting had abnormalities in complete blood count. The most frequent finding was leucocytosis, following normocyte anemia and erytrocite's morphological abnormalities without laboratory signs of anemia. Every tenth patient had abnormalities in two or three cell lines. Complete blood count is probably the most basic investigation in medicine. From the results we can suspect on many different pathologies. Differential blood count should be ordered if we find abnormalities in complete blood count. Physicians should read and evaluate complete blood count with the same dedication as we read electrocardiogram.","PeriodicalId":49350,"journal":{"name":"Zdravniski Vestnik-Slovenian Medical Journal","volume":"45 1","pages":"591-598"},"PeriodicalIF":0.0,"publicationDate":"2015-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81334324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract : Background: Rupture of the tibialis anterior tendon is a rare injury. It can be traumatic or spontaneous. Spontaneous rupture is usually a consequence of degenerative changes of the tendon caused by accompanied diseases. For successful treatment and rehabilitation early diagnosis is mandatory. For diagnosis a clinical examination is most important and ultrasound examination and/or magnetic resonance additionally confirms the diagnosis. Treatment can be operative or conservative with below knee non-weight bearing cast. Conservative treatment is usually decided where ruptures are older than three months, especially in patients with poorer mobility or with accompanied diseases. In the literature there are several techniques considering surgical treatment. Case report: A 56 years old men with diabetes mellitus and polyneuropathy sustained a rupture of the tibialis anterior tendon at injury walking downhill. Rupture was at first unrecognized and was treated as an ankle sprain. After two months he was reexamined and a rupture of the tibialis anterior tendon was diagnosed and surgically reconstructed using semitendinosus tendon graft. Conclusion: Rupture of the anterior tendon of tibialis muscle was reconstructed by using an autologous graft of semitendinosus muscle tendon, in which we achieved good long-term results. Tendon of semitendinosus is suitable because it has properties similar to anterior tendon of tibialis muscle. Because of the similar diameters it is also suitable for bridging of longer defects, such as in our case.
{"title":"Rupture of the anterior tibialis tendon: A review of the literature and case study of reconstruction with semitendinosus tendon in a patient with diabetes mellitus and polyneuropathy","authors":"I. Frangež, Matevž Krašna, T. Nizič-Kos, D. Smrke","doi":"10.6016/ZDRAVVESTN.1262","DOIUrl":"https://doi.org/10.6016/ZDRAVVESTN.1262","url":null,"abstract":"Abstract : Background: Rupture of the tibialis anterior tendon is a rare injury. It can be traumatic or spontaneous. Spontaneous rupture is usually a consequence of degenerative changes of the tendon caused by accompanied diseases. For successful treatment and rehabilitation early diagnosis is mandatory. For diagnosis a clinical examination is most important and ultrasound examination and/or magnetic resonance additionally confirms the diagnosis. Treatment can be operative or conservative with below knee non-weight bearing cast. Conservative treatment is usually decided where ruptures are older than three months, especially in patients with poorer mobility or with accompanied diseases. In the literature there are several techniques considering surgical treatment. Case report: A 56 years old men with diabetes mellitus and polyneuropathy sustained a rupture of the tibialis anterior tendon at injury walking downhill. Rupture was at first unrecognized and was treated as an ankle sprain. After two months he was reexamined and a rupture of the tibialis anterior tendon was diagnosed and surgically reconstructed using semitendinosus tendon graft. Conclusion: Rupture of the anterior tendon of tibialis muscle was reconstructed by using an autologous graft of semitendinosus muscle tendon, in which we achieved good long-term results. Tendon of semitendinosus is suitable because it has properties similar to anterior tendon of tibialis muscle. Because of the similar diameters it is also suitable for bridging of longer defects, such as in our case.","PeriodicalId":49350,"journal":{"name":"Zdravniski Vestnik-Slovenian Medical Journal","volume":"174 1","pages":"649-656"},"PeriodicalIF":0.0,"publicationDate":"2015-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73156158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Patients with cancer are at increased risk for venous thromboembolism (VTE). Cancer-associated VTE increases the burden of malignant disease and has an unfavorable effect on survival. Aim: To establish the safety and efficiency of ambulatory treatment of patients with cancer and VTE. Methods: In retrospective longitudinal cohort study we investigated documentation of all patients with cancer and VTE who were ambulatory treated at our department from November 2005 to February 2011. Their clinical features and complications while on anticoagulant treatment were analyzed. Patients were followed for at least two years from the date of VTE event. Results: 290 patients with cancer and VTE were enrolled (134 women; mean age 68±12 years; 78,2% proximal venous thrombosis (VT); 10% pulmonary embolism (PE); 74,5% metastatic disease). They were treated with low-molecular-weight heparin (LMWH) in the first six months, later on with coumarins. 94 bleeding (33% major and 67% minor) and 41 recurrent VTE events (34,2% PE and 65,8% VT) were recorded. Two-year survival rate was 45,5%. The cause of death was progression of cancer in 87,4%, major bleeding in 2,5% and PE in 1,9% of patients. Advanced stage of cancer, low body mass index and low hemoglobin concentration at initiation of anticoagulant treatment turned out to be the independent prognostic factors of survival. Conclusions: Ambulatory treatment of patients with cancer and VTE is safe and efficient. Survival of patients with cancer and VTE predominantly depends on advanced stage of cancer and general performance status of a patient.
{"title":"OUTPATIENT TREATMENT OF PATIENTS WITH CANCER AND VENOUS THROMBOEMBOLISM","authors":"Urška Cvajnar, A. Mavri, M. Štalc","doi":"10.6016/ZDRAVVESTN.1178","DOIUrl":"https://doi.org/10.6016/ZDRAVVESTN.1178","url":null,"abstract":"Background: Patients with cancer are at increased risk for venous thromboembolism (VTE). Cancer-associated VTE increases the burden of malignant disease and has an unfavorable effect on survival. Aim: To establish the safety and efficiency of ambulatory treatment of patients with cancer and VTE. Methods: In retrospective longitudinal cohort study we investigated documentation of all patients with cancer and VTE who were ambulatory treated at our department from November 2005 to February 2011. Their clinical features and complications while on anticoagulant treatment were analyzed. Patients were followed for at least two years from the date of VTE event. Results: 290 patients with cancer and VTE were enrolled (134 women; mean age 68±12 years; 78,2% proximal venous thrombosis (VT); 10% pulmonary embolism (PE); 74,5% metastatic disease). They were treated with low-molecular-weight heparin (LMWH) in the first six months, later on with coumarins. 94 bleeding (33% major and 67% minor) and 41 recurrent VTE events (34,2% PE and 65,8% VT) were recorded. Two-year survival rate was 45,5%. The cause of death was progression of cancer in 87,4%, major bleeding in 2,5% and PE in 1,9% of patients. Advanced stage of cancer, low body mass index and low hemoglobin concentration at initiation of anticoagulant treatment turned out to be the independent prognostic factors of survival. Conclusions: Ambulatory treatment of patients with cancer and VTE is safe and efficient. Survival of patients with cancer and VTE predominantly depends on advanced stage of cancer and general performance status of a patient.","PeriodicalId":49350,"journal":{"name":"Zdravniski Vestnik-Slovenian Medical Journal","volume":"2 1","pages":"536-543"},"PeriodicalIF":0.0,"publicationDate":"2015-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74477073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background. Metastases to the spleen are considered a rare event generally occurring during the late stage of malignant disease. Isolated metastases are even rarely described. In the past years the number of reported cases in literature has risen mainly due to the improvements of the imaging techniques and the use of FDG-PET/CT in the follow-up of the patients with malignant disease. Even though melanoma can disseminate to any organ, metastases to spleen, found during life, are rare. Moreover, proven isolated metastases in the spleen are even seldomly described. Case report. We report a case of 61-year-old man with known skin melanoma treated in our Institute from 2009. During the regular follow up raised values of S-100 marker and isolated lesions in the spleen found on FDG-PET/CT were described. Due to isolated metastatic disease, splenectomy was indicated. Conclusion. Patients with stage IV. melanoma have poor prognosis, the median survival is estimated to six months. According to studies, metastasectomies for isolated metastases in solid organs can significantly improve survival of these patients. In melanoma patients with FDG-PET/CT proven isolated metastases to the spleen, splenectomy can significantly improve their survival and quality of life.
{"title":"Melanom in izolirane metastaze v vranici-prikaz primera in pregled literature","authors":"Jerica Škedelj, Ivana Žagar, Marko Snoj","doi":"10.6016/ZDRAVVESTN.1146","DOIUrl":"https://doi.org/10.6016/ZDRAVVESTN.1146","url":null,"abstract":"Background. Metastases to the spleen are considered a rare event generally occurring during the late stage of malignant disease. Isolated metastases are even rarely described. In the past years the number of reported cases in literature has risen mainly due to the improvements of the imaging techniques and the use of FDG-PET/CT in the follow-up of the patients with malignant disease. Even though melanoma can disseminate to any organ, metastases to spleen, found during life, are rare. Moreover, proven isolated metastases in the spleen are even seldomly described. Case report. We report a case of 61-year-old man with known skin melanoma treated in our Institute from 2009. During the regular follow up raised values of S-100 marker and isolated lesions in the spleen found on FDG-PET/CT were described. Due to isolated metastatic disease, splenectomy was indicated. Conclusion. Patients with stage IV. melanoma have poor prognosis, the median survival is estimated to six months. According to studies, metastasectomies for isolated metastases in solid organs can significantly improve survival of these patients. In melanoma patients with FDG-PET/CT proven isolated metastases to the spleen, splenectomy can significantly improve their survival and quality of life.","PeriodicalId":49350,"journal":{"name":"Zdravniski Vestnik-Slovenian Medical Journal","volume":"71 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2015-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85746075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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