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The prognostic value of micrometastases found intraoperatively in the first drainig lymph node in gastric cancer patients. 胃癌患者术中首次引流淋巴结微转移的预后价值。
Q4 Medicine Pub Date : 2012-11-01 DOI: 10.6016/1564
T. Jagrič, M. Plankl, A. Ivanecz, M. Horvat, Borut Gajzer, Z. Grubic, S. Potrč, T. Mars
Background: The concept of sentinel lymph node screening has been recently introduced in gastric cancer treatment. Even through micrometastases can be shown reliably by imunohystochemistry, such staining methods are lengthy and laborious, which precludes its intraoperative use. In this study, the clinical and prognostic implications of a new single sentinel lymph node screening for micrometastases concept were evaluated on a small study group.Methods: Twenty-three patients were included in our study. Nine were selected as a control group. The first stained lymph node was defined as the true sentinel lymph node. This lymph node was sent separately for RT-qPCR analysis to determine CEA and CK-20 expression as markers of micrometastases. Patient and tumor characteristics were analysed and possible correlations with micrometastatic involvement were determined.Results: Fourteen patients were found to be N0. Four patients (28.6 %) had micrometastases. Micrometastases were more prominent in patients with diffuse gastric cancer, with higher CA 19–9 values. Patients with micrometastases were also found to be older than those without them.Conclusions: Even through these results indicate the potential use of a single SNL in intraoperative decision making, the sensitivity and specificity of our method has to be evaluated on a larger series, supported by long-term recurrence and survival results.
背景:前哨淋巴结筛查的概念最近被引入到胃癌的治疗中。即使通过免疫组织化学可以可靠地显示微转移,但这种染色方法耗时费力,妨碍了术中使用。在这项研究中,一个小型研究小组评估了一种新的单前哨淋巴结微转移筛查概念的临床和预后意义。方法:23例患者纳入研究。选取9例作为对照组。第一个染色的淋巴结被定义为真前哨淋巴结。该淋巴结被单独送去进行RT-qPCR分析,以确定CEA和CK-20的表达作为微转移的标志物。分析了患者和肿瘤的特征,并确定了与微转移累及的可能相关性。结果:14例患者为0级。微转移4例(28.6%)。微转移在弥漫性胃癌患者中更为突出,CA 19-9值较高。有微转移的患者也比没有微转移的患者年龄大。结论:尽管这些结果表明单个SNL在术中决策中的潜在用途,但我们的方法的敏感性和特异性必须在更大的系列中进行评估,并得到长期复发和生存结果的支持。
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引用次数: 2
Clinical pharmacist report in Psychiatric Hospital Idrija 伊德里贾精神病院临床药师报告
Q4 Medicine Pub Date : 2012-11-01 DOI: 10.6016/1563
Cvetka Bačar Bole
Background: This article presents a new direction of good clinical practice, Clinical Pharmacist Report at the Psychiatric Hospital Idrija. This is a written document intended for a physician (psychiatrist or specialist in internal medicine). By the help of the Report, doctor can make a correct decision about the use of drugs and choice of examinations. It is described in detail when and how the Report can be prepared.Conclusion: Clinical practice has shown that the need for Clinical Pharmacist Reports at the Psychiatric Hospital Idrija exceeds the available personnel capacities , but nevertheless, clinical pharmacist should at least be involved in the treatment of patients taking eight or more medicines. Clinical pharmacist report in the Psychiatric Hospital Idrija is an example of constructive cooperation of different profiles in health profession. It represents an added value in the treatment of psychiatric patients and should be upgraded, because a patient in the hospital environment has practically no chance to consult a pharmacist. A doctor that decides to prescribe medicines contrary to Clinical Pharmacist Report should substantiate and document his decision.
背景:本文介绍了伊德里贾精神病院临床药师报告这一良好临床实践的新方向。这是一份写给内科医生(精神科医生或内科专家)的书面文件。在报告的帮助下,医生可以对药物的使用和检查的选择做出正确的决定。详细说明了何时和如何编写报告。结论:临床实践表明,Idrija精神病医院对临床药剂师报告的需求超过了现有人员的能力,但尽管如此,临床药剂师至少应该参与治疗服用八种或更多药物的患者。Idrija精神病医院的临床药剂师报告是卫生专业不同部门建设性合作的一个例子。它是治疗精神病患者的一种附加价值,应该加以改进,因为病人在医院环境中几乎没有机会咨询药剂师。医生决定违反《临床药师报告》开药的,应当证明并记录其决定。
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引用次数: 0
Which psychophysical colour vision test to use for screening in 3–9 year olds? 哪种心理物理色觉测试适合用于3-9岁儿童的筛查?
Q4 Medicine Pub Date : 2012-10-17 DOI: 10.6016/1021
M. Pompe, B. S. Kranjc
Background: To compare 4 psychophysical colour vision tests in children and to decide which test is most suitable for screening in pre-school and early school-age period. Methods: The first test used was a modified Ishihara plates test (Handaya Co. Ltd., Tokyo). The second test ”Colour vision testing made easy” (CVTME) (T. L. Waggoner, 1994) is also based on pseudoisochromatic plates with child-friendly symbols. The third test used was the ”Neitz test of colour vision” (WPS, 2001) and the fourth was ”Mollon-Reffin Minimalist test” (MRM) (version 0.7, 1994). In the first three tests, the child had to tell what he or she saw in the picture, whereas in the fourth test the child had to pick the coloured button among distractors. Thirty-seven children (19 girls and 18 boys) from 3–9 years of age with normal colour vision (at least one test should be performed without errors) were tested. The number of errors in each of the first 3 tests was registered, whereas in the MRM test the least saturated button distinguished among distractors was registered. Specificity was calculated for each test. Every child was also asked which was his or her favourite test. Results: 16/37 children made one or more errors in the modified Ishihara test, among them all children under the age of 5 years. Nine children made 1 error, three made 2, two made 3 and two children made 5 errors. 8/37 children made 1–3 mistakes in the CVTME test. Four children made one mistake, three made two and one child made three mistakes. All tested children made at least one mistake in the Neitz test. All gave a wrong description for the figure in the 6th position of the test. Two 3-year-old girls were not able to perform the test. The MRM test was not performed in full by 10/37 children. Most of these children made errors in the tritan colour vision axis. The highest specificity in all 3 age groups was calculated for CVTME test and MRM test. 28/37 children chose the MRM test as their favourite. Conclusions: The modified Ishihara colour test has turned out to be too difficult and therefore unreliable in the youngest children. For children under 5 years of age CVTME was more reliable in this study. For all ages the MRM test was the easiest to perform. Most children in this study subjectively preferred the MRM test.
背景:比较4种儿童心理物理色觉测试,以确定哪种测试最适合在学龄前和学龄早期进行筛查。方法:采用改良石原板法(Handaya株式会社,东京)。第二个测试“颜色视觉测试变得容易”(T. L. Waggoner, 1994)也是基于带有儿童友好符号的假等色板。使用的第三个测试是“Neitz色视觉测试”(WPS, 2001),第四个是“Mollon-Reffin极简测试”(MRM)(版本0.7,1994)。在前三个测试中,孩子们必须说出他或她在图片中看到了什么,而在第四次测试中,孩子们必须在干扰物中选择彩色按钮。对37名3-9岁色视力正常的儿童(19名女孩和18名男孩)进行了测试(至少一次测试应无错误)。记录了前3个测试中每个测试的错误数,而在MRM测试中,记录了在干扰物中区分的最不饱和按钮。计算每个试验的特异性。每个孩子也被问到他或她最喜欢的测试是什么。结果:16/37的儿童在修改后的石原测验中出现一个或多个错误,其中均为5岁以下儿童。9个孩子犯了1个错误,3个犯了2个,2个犯了3个,2个犯了5个。8/37的孩子在CVTME测试中犯了1-3个错误。四个孩子犯了一个错误,三个孩子犯了两个错误,一个孩子犯了三个错误。所有参加测试的孩子在Neitz测试中至少犯了一个错误。对测试第6位的数字都给出了错误的描述两个3岁的女孩无法进行测试。10/37的儿童没有进行完整的MRM测试。这些孩子中的大多数在三色视觉轴上犯了错误。计算CVTME试验和MRM试验在所有3个年龄组中的最高特异性。28/37的孩子选择了MRM测试作为他们的最爱。结论:经过改进的石原颜色测试在最小的孩子身上太难了,因此不可靠。对于5岁以下的儿童,CVTME在本研究中更为可靠。对于所有年龄段的人来说,MRM测试是最容易进行的。在本研究中,大多数儿童主观上更喜欢MRM测试。
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引用次数: 7
Our first experience with subthreshold diode laser in the treatment of macular edema. 我们首次使用阈下二极管激光治疗黄斑水肿。
Q4 Medicine Pub Date : 2012-10-17 DOI: 10.6016/1022
D. Sevšek, A. Gril, S. Farac
Authors describe their first experience with the treatment of macular edema of different etiology with subtreshold diode micropulse laser (577 nm), which does not cause any damage to the retinal pigment epithelium. Therapy with subtreshold diode micropulse laser was used for treating macular edema as a result of diabetic retinopathy, branch retinal vein occlusion and central serous chorioretinopathy. Before treatment, all patients were examinated by optical coherence tomography (OCT) to measure  their retinal thickness and visual acuity. In some patients fluorescein angiography (FA) was also performed before treatment. Patients were monitored on monthly basis by measuring their  visual acuity and retinal thickness. Using OCT to measure macular edema, all patients showed a reduced macular edema at their first monthly check-up. These results show that the therapy with subtreshold diode micropulse laser is successful in diminishing macular edema.
作者描述了他们用亚阈值二极管微脉冲激光(577nm)治疗不同病因的黄斑水肿的第一次经验,该激光不会对视网膜色素上皮造成任何损伤。应用阈下二极管微脉冲激光治疗糖尿病视网膜病变、视网膜分支静脉阻塞和中枢性浆液性脉络膜视网膜病变引起的黄斑水肿。治疗前,所有患者均接受光学相干断层扫描(OCT)检查,测量视网膜厚度和视力。一些患者在治疗前还进行了荧光素血管造影(FA)。每月监测患者的视力和视网膜厚度。使用OCT测量黄斑水肿,所有患者在第一次月度检查时均显示黄斑水肿减轻。这些结果表明,亚阈值二极管微脉冲激光治疗黄斑水肿是成功的。
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引用次数: 1
Diabetes in pregnancy 妊娠期糖尿病
Q4 Medicine Pub Date : 2012-10-01 DOI: 10.6016/1031
Simona Kovačec, M. Krajnc, M. Cokolic, A. Zavratnik
Given the increasing prevalence of obesity, type 2 diabetes mellitus (T2DM), and gestational diabetes mellitus (GDM), the number of women who have some form of diabetes during their pregnancies is increasing. Diabetes in pregnancy entails an increased risk of perinatal mortality and morbidity, as well as complications in mother. These are mainly the result of fetal exposure to maternal hyperglycaemia. Undelayed achievement of normoglycemia is therefore crucial for optimizing maternal and fetal outcomes in all women with diabetes during pregnancy, regardless of the type of diabetes. In light of this, we would like to address the importance of early detection of likely prepregnancy diabetes – mostly T2DM, and the value of preconception care in women with preexisting T2DM and type 1 diabetes mellitus (T1DM). This review is aimed to discus pregestational and gestational diabetes and the associated health risk to the developing fetus and the mother. The management should take into account the clinical evidence-based guidelines for the treatment of T2DM published by the Slovenian Endocrine Society in June 2011.
鉴于肥胖、2型糖尿病(T2DM)和妊娠期糖尿病(GDM)的患病率日益增加,怀孕期间患有某种形式糖尿病的妇女人数正在增加。妊娠期糖尿病会增加围产期死亡率和发病率,以及母亲并发症的风险。这些主要是胎儿暴露于母体高血糖的结果。因此,无论糖尿病类型如何,及时实现正常血糖对于优化妊娠期所有糖尿病妇女的母胎结局至关重要。鉴于此,我们想强调早期发现可能的孕前糖尿病(主要是2型糖尿病)的重要性,以及对已有2型糖尿病和1型糖尿病(T1DM)的妇女进行孕前护理的价值。本文旨在探讨妊娠期和妊娠期糖尿病及其对发育中的胎儿和母亲的健康风险。管理层应考虑2011年6月斯洛文尼亚内分泌学会发布的T2DM治疗临床循证指南。
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引用次数: 0
Ciprofloxacin-induced cholestatic liver injury - a case report. 环丙沙星致胆汁淤积性肝损伤1例报告。
Q4 Medicine Pub Date : 2012-09-01 DOI: 10.6016/1000
M. Vujasinovic, Zdenko Kikec, M. Hafner, Vera Ferlan Marolt
Background: Drug-induced liver injury has been described for a large number of drugs. It is a common cause of drug withdrawal from the market. Ciprofloxacin is a commonly prescribed fluoroquinolone antibiotic and is a rare cause of hepatotoxicity. To our best knowledge this is the first case of ciprofloxacin-induced cholestatic liver injury in Slovenia.Case report: A 19year old man has been treated with ciprofloxacin at a daily dose of 500 mg twice a day due to a mild respiratory infection. After twenty days he was admitted to hospital because of jaundice. Laboratory findings showed a typical pattern of acute cholestatic liver failure, which was additionally confirmed by the liver biopsy. The patient was treated symptomatically. Ten months later the patient’s clinical status is stabile with a normal bilirubin level and mildly elevated alkaline phosphatase and gamma-glutamyltransferase. Conclusion: Although severe hepatotoxicity after the administration of ciprofloxacin is rare, physicians should be cautious and alert to its side-effects.
背景:药物性肝损伤已被大量的药物所描述。这是药物退出市场的常见原因。环丙沙星是一种常用的氟喹诺酮类抗生素,是一种罕见的肝毒性原因。据我们所知,这是斯洛文尼亚第一例环丙沙星引起的胆汁淤积性肝损伤。病例报告:一名19岁男子因轻度呼吸道感染接受环丙沙星治疗,每日剂量为500毫克,每日两次。20天后,他因黄疸病住进了医院。实验室结果显示急性胆汁淤积性肝衰竭的典型模式,肝脏活检也证实了这一点。对病人进行了对症治疗。10个月后,患者临床状况稳定,胆红素水平正常,碱性磷酸酶和谷氨酰转移酶轻度升高。结论:虽然使用环丙沙星后出现严重肝毒性的病例很少,但医师应谨慎警惕其副作用。
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引用次数: 0
Up-to-date management of patients with blunt abdominal trauma 钝性腹部创伤患者的最新处理
Q4 Medicine Pub Date : 2012-08-01 DOI: 10.6016/1010
A. Pleskovič, P. Gradisek, B. Kremžar
Background: In the last few years new approaches to the diagnosis and management of abdominal trauma were introduced, and in addition, monitoring of individual organ function in the intensive care units has become an almost daily practice. In our article we review the principles of assessment and management of injured individual abdominal organs from surgical and intensive care medicine’s point of view. Conclusions: Appropriate diagnostics and, precise and timely decision for surgery are the most important factors in the management of patients with blunt abdominal trauma. The mechanism of injury, presence of concomitant injuries, lifethreatening condition and competence of medical staff have to be taken into consideration. The most often injured organs, spleen and liver, are nowadays managed mostly non-operatively. Such an approach has resulted in an increased admission of patients to the intensive care unit, with an attempt to prevent secondary organ dysfunction and multiple-organ failure. These new treatment options have contributed to lower morbidity and mortality and improved quality of life.
背景:在过去的几年里,腹部创伤的诊断和管理的新方法被引入,此外,监测个别器官功能在重症监护病房已成为几乎每天的做法。在我们的文章中,我们从外科和重症监护医学的角度回顾了评估和处理单个腹部器官损伤的原则。结论:正确的诊断和准确及时的手术决定是治疗钝性腹部创伤的最重要因素。必须考虑到受伤的机制、是否伴有损伤、危及生命的情况和医务人员的能力。最常见的损伤器官,脾和肝,现在大多是非手术治疗。这种方法增加了重症监护病房收治病人的数量,试图防止继发性器官功能障碍和多器官衰竭。这些新的治疗方案有助于降低发病率和死亡率,提高生活质量。
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引用次数: 0
Imaging of head and neck tumors – the role of CT perfusion 头颈部肿瘤的影像学- CT灌注的作用
Q4 Medicine Pub Date : 2012-06-01 DOI: 10.6016/860
K. Popovič, S. Bisdas, P. Strojan
Background: The purpose of this article is to describe the role of functional radiological imaging modality–CT perfusion in the evaluation of head and neck tumors.Methods: Perfusion CT imaging provides a rapid evaluation of tissue perfusion and can be easily implemented in every head and neck CT protocol. The determination of tissue perfusion using CT is based on examining the relationships between the arterial, tissue and potentially the venous enhancement after the introduction of a bolus of contrast material. The quantification of the perfusion values allows us to determinate the processes of neovascularization, also known as angiogenesis, essential for the growth of head and neck tumors. Conclusions: Perfusion CT is a robust, accessible and promising method for the assessment of functional parameters on the tissue level. It helps outlining the malignant tissue as well as differentiating recurrent disease from nonspecific post-therapeutic changes and can be used as a therapeutic monitoring tool during and after tumor therapy.
背景:本文的目的是描述功能放射成像模式- ct灌注在头颈部肿瘤评估中的作用。方法:灌注CT成像可快速评估组织灌注情况,可方便地应用于各种头颈部CT方案。使用CT确定组织灌注是基于在注入造影剂后检查动脉、组织和潜在的静脉增强之间的关系。灌注值的量化使我们能够确定新生血管的过程,也称为血管生成,对头颈部肿瘤的生长至关重要。结论:灌注CT是一种在组织水平上评估功能参数的可靠、易获得和有前途的方法。它有助于概述恶性组织,以及区分复发性疾病与非特异性治疗后变化,可作为肿瘤治疗期间和之后的治疗监测工具。
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引用次数: 0
The impact of endometriosis on in vitro fertilization outcome 子宫内膜异位症对体外受精结果的影响
Q4 Medicine Pub Date : 2012-06-01 DOI: 10.6016/857
M. Herzog, Katarina Pavšlar, A. Vogler
Introduction: Nowadays, endometriosis represents the most frequent cause of female infertility.The treatment of choice is by all means laparoscopic surgery, which results in more than a 60 % pregnancy rate, regardless of the stage of the disease. For the rest of patients in vitro fertilization (IVF) is the most appropriate treatment of choice. Views of the impact of endometriosis on IVF outcome remain controversial and subject to debate. Whereas some studies have documented that endometriosis is associated with reduced pregnancy rates, others failed to prove this association. The present study was designed to elucidate whether or not endometriosis affects IVF outcome at our institution. The study was retrospective, statistical significance was considered at p ≤ 0.05.Methods: In 96 patients (group A) that underwent IVF program the only cause of infertility was endometriosis which had been previously treated surgically. Sixty-two (64.6 %) patients had minimal or mild endometriosis (group C) and 34 (35.4 %) had moderate or severe stage of the disease (group D). The control group (group B) consisted of 305 patients who underwent IVF procedure for tubal or idiopathic infertility. Among other variables, pregnancy rate per cycle and per embryo transfer (ET), take-home-baby rate (THBR) per cycle and per ET were compared between the study and control groups of patients as well as between both groups with endometriosis. The study was retrospective. Statistical significance was defined as p ≤ 0.05.Results: No statistically significant differences were found in any of the compared parameters. In Group “A” pregnancy rate per cycle and per ET was 41.7 % and 46.8 % respectively, compared to Group “B” where it was 36.4 % and 40.5 % respectively. THBR per cycle and per ET in Group “A” was 35.4 % and 43.0 %, whereas in the control group it was 30.5 % and 33.9 % respectively. Pregnancy rate per cycle and per ET in Group “C” was 40.3 % and 48.1 % whereas in Group “D” it was 44.1 % and 55.6 % respectively. THBR per cycle and per ET in Group “C” was 33.9 % and 40.4 % whereas in Group “D” it was 38.2 % and 48.1 % respectively. Conclusions: Endometriosis does not affect the outcome of IVF procedures. We believe that appropriate surgical technique is of paramount importance in patients with endometriosis, leading to favourable IVF outcomes.
简介:如今,子宫内膜异位症是女性不孕的最常见原因。治疗的选择是通过腹腔镜手术,结果超过60%的怀孕率,无论疾病的阶段。对于其余患者,体外受精(IVF)是最合适的治疗选择。子宫内膜异位症对体外受精结果的影响仍然存在争议。虽然一些研究证明子宫内膜异位症与妊娠率降低有关,但其他研究未能证明这种联系。本研究旨在阐明子宫内膜异位症是否会影响我们机构的体外受精结果。本研究为回顾性研究,p≤0.05认为有统计学意义。方法:96例(A组)经体外受精治疗的不孕不育的唯一原因是子宫内膜异位症。62例(64.6%)患者有轻微或轻度子宫内膜异位症(C组),34例(35.4%)患者有中度或重度子宫内膜异位症(D组)。对照组(B组)包括305例因输卵管性或特发性不孕症接受体外受精手术的患者。在其他变量中,研究人员比较了研究组和对照组之间以及子宫内膜异位症患者两组之间的每个周期和每个胚胎移植(ET)的妊娠率,每个周期和每个ET的带回家婴儿率(THBR)。该研究是回顾性的。统计学意义定义为p≤0.05。结果:各参数比较无统计学差异。A组每个周期和每个ET的妊娠率分别为41.7%和46.8%,而B组的妊娠率分别为36.4%和40.5%。A组每周期THBR和每ET分别为35.4%和43.0%,对照组分别为30.5%和33.9%。C组每周期妊娠率和每ET妊娠率分别为40.3%和48.1%,D组分别为44.1%和55.6%。C组每周期THBR和每ET分别为33.9%和40.4%,D组分别为38.2%和48.1%。结论:子宫内膜异位症不影响体外受精手术的结果。我们相信适当的手术技术对子宫内膜异位症患者至关重要,从而获得良好的体外受精结果。
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引用次数: 1
Treatment of movement disorders using deep brain stimulation - illustrative case reports and technical notes. 使用深部脑刺激治疗运动障碍-说明性病例报告和技术说明。
Q4 Medicine Pub Date : 2012-05-01 DOI: 10.6016/837
T. Strojnik, D. Flisar, I. Drstvenšek
Operative neuromodulation is the field of electrically or chemically altering the signal transmission in the nervous system by implanted devices in order to excite, inhibit or tune the activities of neurons or neural networks to produce therapeutic effects. Deep brain stimulation (DBS) is an important component of the therapy of movement disorders and has almost completely replaced high-frequency coagulation of brain tissue in stereotactic neurosurgery. This article presents the first DBS cases in Slovenia. In the article the technical features and adjustments of magnetic resonance (MR) imaging and development of a new microdrive, which was clinically successfully tested, are described and discussed.
手术神经调节是指通过植入的装置以电或化学方式改变神经系统中的信号传递,从而激发、抑制或调节神经元或神经网络的活动,从而产生治疗效果的领域。脑深部电刺激(DBS)是运动障碍治疗的重要组成部分,几乎完全取代了立体定向神经外科中脑组织的高频凝固。本文介绍了斯洛文尼亚的第一例星展银行病例。本文介绍了磁共振成像的技术特点和调整方法,并对一种新型微驱动器的研制进行了介绍和讨论。
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引用次数: 0
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Zdravniski Vestnik-Slovenian Medical Journal
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