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New International federation of gynecology and obstetrics (FIGO) staging system of gynecological cancers 新的国际妇产科学联合会(FIGO)妇科肿瘤分期系统
Q4 Medicine Pub Date : 2011-04-01 DOI: 10.6016/78
I. Takač, Nina Fokter
Background: The revised FIGO staging system for carcinoma of the vulva, cervix uteri, and endometrium, which had been previously revised in 1988, 1994, and 1988, respectively, was approved by the International Federation of Gynecology and Obstetrics (FIGO) in September 2008. In addition to the revisions of previously existing staging systems, a new staging system for uterine sarcomas was introduced at the same time.Conclusions: The changes mostly addressed the prognostic disproportions between certain (sub) stages that had been shown in numerous statistical analyses. Vulvar cancer staging has undergone the greatest changes.
背景:修订后的FIGO外阴癌、子宫颈癌和子宫内膜癌分期体系分别于1988年、1994年和1988年修订,并于2008年9月获得国际妇产科学联合会(FIGO)批准。除了对原有分期系统的修订外,同时还引入了一种新的子宫肉瘤分期系统。结论:这些变化主要解决了在许多统计分析中显示的某些(亚)阶段之间的预后不平衡。外阴癌的分期变化最大。
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引用次数: 1
Treatment of acute respiratory infections in Slovenian children with ivy leaf extract syrup. 常青藤叶提取物糖浆治疗斯洛文尼亚儿童急性呼吸道感染。
Q4 Medicine Pub Date : 2011-04-01 DOI: 10.6016/82
A. Beden, J. Perko, Robert Terčelj, S. Kreft
Background: The ivy leaf extract is a natural substance with secretolytic effect. Its efficacy and safety have been documented in several randomized, double-blind placebo-controlled trials. The aim of our study was to confirm the safety of ivy leaf extract in Slovenian children with acute inflammatory airway disease and to investigate the course of treatment.Methods: 193 children with clinical signs of acute airway disease, aged 2 to 14 years were included in a prospective postmarketing study. At the beginning of the study, 7-day treatment with syrup of ivy leaf extract was started.Results: The treatment was effective in 93.7 % of children, who showed an improvement of clinical symptoms. The proportion of children with productive cough was 43.6 % at first visit and 84.9 % at second visit. Skin allergy as a side effect was reported in one child.Conclusions: The study demonstrated that the treatment with ivy leaf extract is safe in children with acute inflammatory airway disease. The quality of sputum and frequency of cough changed during the treatment, and the majority of physicians and patients estimated that the treatment was more effective than in previous episodes of the disease when they had not received this drug.
背景:常青藤叶提取物是一种具有促分泌作用的天然物质。它的有效性和安全性已在几项随机双盲安慰剂对照试验中得到证实。我们研究的目的是确认常青藤叶提取物对斯洛文尼亚急性炎症性气道疾病儿童的安全性,并调查治疗过程。方法:193名2 ~ 14岁有急性呼吸道疾病临床症状的儿童纳入一项前瞻性上市后研究。在研究开始时,开始用常春藤叶提取物糖浆治疗7天。结果:治疗有效率为93.7%,患儿临床症状明显改善。第一次就诊时有生产性咳嗽的患儿占43.6%,第二次就诊时有生产性咳嗽的患儿占84.9%。据报道,一名儿童出现了皮肤过敏的副作用。结论:常青藤叶提取物治疗儿童急性炎性气道疾病是安全的。在治疗期间,痰的质量和咳嗽的频率发生了变化,大多数医生和患者估计治疗比以前未服用该药时的治疗更有效。
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引用次数: 2
Endobronchial ultrasound for the diagnosis and treatment of mediastinal lesions 支气管超声对纵隔病变的诊断和治疗
Q4 Medicine Pub Date : 2011-02-01 DOI: 10.6016/51
A. Rozman, M. M. Malovrh, K. Osolnik, Luka Camlek, N. Triller
Abstract: Bronchoscopy with convex probe ultrasound in combination with transbronchial fine-needle aspiration biopsy is a relatively new, minimally invasive method that can also be used in an outpatient setting. It is indicated for staging of the mediastinal and hilar lymph nodes in patients with lung cancer, for the diagnosis of lung and mediastinal tumors, for the diagnosis of mediastinal lymphadenopaty and for the diagnosis and aspiration of mediastinal cysts. The method has a high diagnostic accuracy, which makes it comparable to more invasive diagnostic methods. At the same time it is less invasive for patients and offers a better safety profile.
摘要:支气管镜与凸探头超声联合经支气管细针穿刺活检是一种相对较新的微创方法,也可用于门诊。适用于肺癌患者纵隔及肺门淋巴结的分期,肺及纵隔肿瘤的诊断,纵隔淋巴结肿大的诊断,纵隔囊肿的诊断及抽吸。该方法具有较高的诊断准确性,可与更具侵入性的诊断方法相媲美。同时,它对患者的侵入性较小,并提供更好的安全性。
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引用次数: 0
Alcohol related harm in Slovenia 在斯洛文尼亚与酒精有关的危害
Q4 Medicine Pub Date : 2011-02-01 DOI: 10.6016/718
Katja Kovše, Sonja Tomšič, B. M. Ponikvar, Petra Nadrag
Background: Alcohol consumption is one of the major avoidable risk factors for chronic diseases, injuries and violence. Overall there is a causal relationship between alcohol consumption and more than 60 types of disease and injury. For some of them alcohol is the only possible cause and so they are wholly (100 %) attributable to alcohol.Methods: We have analysed the data on mortality and hospitalisation of Slovenian citizens because of causes wholly attributable to alcohol. We used mortality and hospitalisation data from the National Institute of Public Health’s healthcare databases »Database of Death certificates« and »Data on in-hospital treatments for diseases, injuries and poisoning«. We present the situation in Slovenia in the period from 2007 to 2009 with gender and regional differences analysis. With the mortality data for the period from 2004 to 2008 we also present the impact of socio-economic differences on the mortality wholly attributable to alcohol consumption in Slovenia. For bivariate analysis of the connection between variables we used Chi-square test.Results: In the period from 2007 to 2009 there were on average 811 deaths, of which 509 were premature (4.4 % of all deaths and 12.3 % of all premature deaths), 3799 hospitalisations and 90,589 hospital days (1.3 % of all hospitalisations and 3.8 % of all hospital days in the country in a calendar year) because of causes wholly attributable to alcohol in Slovenia. Men have higher relative risk for death and for hospitalisation because of causes wholly attributable to alcohol than women, and also residents of Eastern Slovenia have higher relative risk than residents of Western Slovenia. Wholly alcohol-attributable mortality is the biggest among residents of the least developed municipalities and is decreasing with the increase of municipality development.Conclusions: Hazardous and harmful alcohol consumption is a big public health problem in Slovenia and it contributes to health inequalities, so activities to reduce its consequences should be increased.
背景:饮酒是慢性病、伤害和暴力的主要可避免风险因素之一。总的来说,饮酒与60多种疾病和伤害之间存在因果关系。对他们中的一些人来说,酒精是唯一可能的原因,所以他们完全(100%)归因于酒精。方法:我们分析了斯洛文尼亚公民因完全归因于酒精的原因而死亡和住院的数据。我们使用的死亡率和住院数据来自国家公共卫生研究所的卫生保健数据库“死亡证明数据库”和“疾病、伤害和中毒住院治疗数据”。我们介绍了斯洛文尼亚2007年至2009年期间的情况,并分析了性别和区域差异。根据2004年至2008年期间的死亡率数据,我们还展示了社会经济差异对斯洛文尼亚完全由酒精消费造成的死亡率的影响。对于变量之间联系的双变量分析,我们使用卡方检验。结果:在2007年至2009年期间,斯洛文尼亚平均有811人死亡,其中509人过早死亡(占所有死亡人数的4.4%,占所有过早死亡人数的12.3%),3799人住院,90,589个住院日(占全国一历年所有住院人数的1.3%,占全国所有住院日的3.8%),原因完全可归因于酒精。男性因完全由酒精引起的原因而死亡和住院的相对风险高于女性,斯洛文尼亚东部居民的相对风险也高于斯洛文尼亚西部居民。在最不发达城市的居民中,完全由酒精引起的死亡率最高,并随着城市发展的增加而下降。结论:危险和有害的酒精消费是斯洛文尼亚的一个重大公共卫生问题,它助长了健康不平等,因此应加强减少其后果的活动。
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引用次数: 0
Sonographic measurements of renal size in slovenian population of children 斯洛文尼亚儿童肾大小的超声测量
Q4 Medicine Pub Date : 2011-01-01 DOI: 10.6016/92
Andreja Dvoršak Erker, A. Gregorič
Background: Kidney size is an important parameter for evaluating normal kidney development and growth. The purpose of our study was to determine normal range of kidney size according to age, weight and height in our population of children. Patients and methods: 591 children and adolescents referred for abdominal sonography were enrolled. There were 291 boys and 300 girls aged between 0 month and 20 years. Children with known renal disease or abnormal renal ultrasound findings were excluded from the study. The renal length, width and depth were measured on the maximal longitudinal renal diameter and on the transverse diameter at the hilar region, perpendicular to the first measurement. Each kidney was measured twice. Once with the patient in supine and once with the patient in prone position. The renal volume was calculated from the measurements. Results: There were no statistically significant differences in kidney size between boys and girls (p> 0.566). The difference in lenght between left and right kidney was small but statistically significant (p< 0.007). Left kidney was longer and had greater volume than the right one. We presented some tables with normal values of kidney length and volume according to age, body weight and body height for our population of children and young people. Conclusions: We believe that our tables with normal values of kidney length and volume will provide a useful references for kidney evaluation by ultrasonography in children. We suggest correlation with body height for the kidney length and correlation with body weight for the kidney volume evaluation.
背景:肾脏大小是评价肾脏正常发育和生长的重要指标。我们研究的目的是根据我们的儿童人群的年龄、体重和身高来确定肾脏大小的正常范围。患者和方法:591名儿童和青少年接受腹部超声检查。其中男孩291名,女孩300名,年龄在0个月至20岁之间。已知肾脏疾病或肾脏超声检查结果异常的儿童被排除在研究之外。分别在肾最大纵径处和肾门区横径处测量肾脏的长度、宽度和深度,与第一次测量垂直。每个肾脏测量两次。一次为仰卧位,一次为俯卧位。根据测量结果计算肾容积。结果:男孩和女孩肾脏大小差异无统计学意义(p> 0.566)。左右肾长度差异虽小,但有统计学意义(p< 0.007)。左肾比右肾长,体积大。我们为我们的儿童和青少年提供了一些根据年龄、体重和身高的肾脏长度和体积正常值的表格。结论:我们的肾脏长度和体积正常值表将为儿童肾脏超声检查提供有益的参考。我们建议肾脏长度与身高相关,肾脏体积评估与体重相关。
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引用次数: 1
Prevention of sudden cardiac death in young athletes 预防年轻运动员心源性猝死
Q4 Medicine Pub Date : 2010-11-01 DOI: 10.6016/348
K. A. Juvan, P. Zupet
Sudden cardiac deaths in young athletes (lessthan 35 years old) are rare though highly publicizedtragedies, occurring mainly in athletes withunderlying cardiovascular diseases. Since thesediseases often have a clinically silent course,they should be actively searched for by preparticipationscreening. Preparticipation screeningof athletes varies among different countries.However, a common European protocol hasbeen proposed, which comprises a history, clinicalexamination, and 12-lead electrocardiogram(ECG). The inclusion of ECG is based mainly onItalian results, which showed increased sensitivityof such screening for a majority of cardiovasculardiseases responsible for sudden cardiacdeath (cardiomyopathies, channelopaties, cardiacconduction tissue diseases). Timely diagnosisof such cardiovascular diseases, abstinence fromexercise of moderate to high intensity, pharmacotherapyand other treatment modalities helpto prevent sudden cardiac deaths and progressionof disease in the affected athletes.
年轻运动员(小于35岁)的心脏性猝死是罕见的,尽管这类悲剧被高度宣传,主要发生在有潜在心血管疾病的运动员身上。由于这些疾病通常有一个临床沉默的过程,他们应该通过参与前筛查积极寻找。运动员的赛前筛查因国家而异。然而,已经提出了一个共同的欧洲方案,包括病史、临床检查和12导联心电图(ECG)。纳入ECG主要是基于意大利的研究结果,该结果显示这种筛查对大多数导致心源性猝死的心血管疾病(心肌病、通道病变、心传导组织疾病)的敏感性增加。及时诊断此类心血管疾病,戒除中高强度运动,药物治疗和其他治疗方式有助于预防受影响运动员的心源性猝死和疾病进展。
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引用次数: 3
Improving diagnostics of pulmonary embolism with clinical prediction models in a clinic of pulmonary diseases 应用肺疾病临床预测模型提高肺栓塞诊断率
Q4 Medicine Pub Date : 2010-10-01 DOI: 10.6016/338
A. Marin, Igor Požek, R. Erzen, P. M. Brguljan, M. Košnik
Purpose of the Study: Clinical prediction modelshave been developed to assess the pre-testprobability for pulmonary embolism (PE). TheWells model and the revised Geneva score arethe two most well studied. Our purpose was tocompare the two prediction models, and indentifythe frequent clinical findings of PE in patientsadmitted to the University Clinic of Pulmonaryand Allergic Diseases Golnik.Methods: In 100 random emergency departmentpatients and hospital inpatients withsuspected PE and performed pulmonary CTangiography (CTPA) as the gold standard, a retrospectiveassessment of the clinical probabilityof PE by the Wells rule and the revised Genevascore was made. ECG, D-dimer, NT-proBNP, arterialblood gas analysis, chest X-ray, CTPA and13 other clinical findings were analysed as well.Results: Average age was 65 years (SD 14.5), 39 %were male. The overall prevalence of PE was33 %. The rates of PE in low, moderate, and highPE risk groups as determined according to theWells model and the revised Geneva score were3.7, 53,1, 100, and 14.3, 32.1, 83.3 %, respectively.ROC analysis showed that the Wells model wasstatistically more accurate than the Geneva scorewith the area under the curve (AUC) in Wellsmodel 0.85 (95 % CI 0.762–0.936) and in Genevascore 0.73 (95 % CI 0.612–0.838). Suddendyspnea, active malignancy, venous thromboembolism(VTE) history, estrogen therapy, deepvein thrombosis (DVT) signs, ECG changes andlower PaCO2 were significantly more frequent inPE group. All patients with PE had an increasedconcentration of D-dimer, and no PE were diagnosedin the group of patients with normalD-dimer. CTPA was ordered in 17 % of patientswith low pre-test probability of PE according toWells criteria and normal D-dimer. Conclusions: The Wells model is more accuratethan the Geneva scoring system for the diagnosisof PE in patients admitted to a pulmonaryclinic. Additional findings, such as sudden dyspnea,estrogen therapy, ECG changes and lowerPaCO2, should always be incorporated in clinicalassessment of PE. Adding the Wells algorithm tothe clinical pathway for PE management mightslightly decrease the number of CTPA.
研究目的:已经建立了临床预测模型来评估肺栓塞(PE)的检测前概率。威尔斯模型和修订后的日内瓦分数是研究得最多的两个模型。我们的目的是比较两种预测模型,并确定在大学肺部和过敏性疾病诊所就诊的患者中PE的常见临床表现。方法:随机选取100例疑似PE的急诊科患者和医院住院患者,以行肺造影(CTPA)为金标准,采用Wells规则和修订Genevascore对PE的临床概率进行回顾性评价。并分析了心电图、d -二聚体、NT-proBNP、动脉血气分析、胸片、CTPA等13项临床表现。结果:平均年龄65岁(SD 14.5),男性占39%。PE的总患病率为33%。根据wells模型和修订后的Geneva评分,低、中、高PE风险组的PE发生率分别为3.7、53、1100和14.3%、32.1%和83.3%。ROC分析显示,Wells模型的曲线下面积(AUC)为0.85 (95% CI 0.762-0.936), Genevascore的AUC为0.73 (95% CI 0.612-0.838),在统计学上优于Geneva评分。pe组患者突发性呼吸困难、活动性恶性肿瘤、静脉血栓栓塞(VTE)史、雌激素治疗、深静脉血栓形成(DVT)征象、心电图改变及PaCO2降低的发生率显著高于pe组。所有PE患者的d -二聚体浓度均升高,正常组未诊断为PE。根据toWells标准和正常d -二聚体,17%的PE检测前概率较低的患者接受CTPA治疗。结论:在肺科门诊就诊的患者中,Wells模型比Geneva评分系统诊断PE更准确。其他发现,如突发性呼吸困难、雌激素治疗、心电图改变和paco2降低,应始终纳入PE的临床评估。将Wells算法添加到PE管理的临床路径中可能会略微减少CTPA的数量。
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引用次数: 0
Why should one join a TT program? Ask a colleague! - or experience after a dozen of TT workshops 为什么要参加TT课程?问问同事吧!——或者在参加了十几次TT研讨会之后的经验
Q4 Medicine Pub Date : 2010-10-01 DOI: 10.6016/343
Ž. Novak, V. Cerar, Z. R. Primec, V. Dolžan, L. Steblovnik, M. Hawlina
Regarding medical science and profession everybodystrives to be updated. We as physicianshave never, however, been trained how to traintrainees, even though adult education is a continuouslydeveloping science as well. This scienceoffers to trainers more efficient tools to teach, appraiseand assess trainees in a rather short timeavailable. We owe it to ourselves and medicine totrain new specialists in such a way that they willbe competent in their specialities. As trainers wecan positively contribute to higher self-reflectionand responsibility of trainees with introductoryappraisal–it is so nice when mentor knows theCV of the trainee in advance–and with repeatingthe appraisal in regular intervals. The importanceof solid basic knowledge and continuousassessment of theoretical knowledge, practicalskills and, above all, of attitude and behaviouris stressed. The first audit cycle of Training thetrainers workshops will not be completed untilafter some years. But what is already evident isthe fact that trainers are offered positive, usefuland enjoyable tools.
对于医学科学和专业,大家都力求与时俱进。尽管成人教育也是一门不断发展的科学,但作为医生,我们从来没有被训练过如何培训学员。这门科学为培训师提供了更有效的工具,在相当短的时间内对学员进行教学、评估和评估。为了我们自己和医学界,我们有责任培养新的专家,使他们能够胜任自己的专业。作为培训师,我们可以通过介绍性评估积极地促进受训者的自我反思和责任感——导师提前知道受训者的情况是很好的——并定期重复评估。强调扎实的基础知识和不断评估理论知识、实践技能,尤其是态度和行为的重要性。培训培训师讲习班的第一个审计周期将在几年后完成。但已经很明显的是,培训师得到了积极、有用和令人愉快的工具。
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引用次数: 1
First transfemoral biologic aortic valve implantation in Slovenia 斯洛文尼亚首例经股生物主动脉瓣植入术
Q4 Medicine Pub Date : 2010-10-01 DOI: 10.6016/342
M. Bunc, K. A. Juvan, J. Ambrožič, Š. Mušič, Bojan Kontestabile, A. Cerar, Irena Lopatič, N. Lakič, D. Zorman
Calcified aortic stenosis is the most frequentvalvular heart disease in the Western world. Itis a progressive, degenerative, atheroscleroticlikeprocess that involves the aortic valve withincreasing prevalence as the population ages.Surgical aortic valve replacement is the treatmentof choice for patients with severe, symptomaticaortic stenosis, but it has limitations inold patients with high perioperative risk and inpatients with comorbidities. A new method ofpercutanous aortic valve implantation has beendeveloped recently. It is indicated in symptomaticpatients with high perioperative risk.Case report: A case of a 83-year-old female patientwith severe, symptomatic aortic valve stenosisand a high haemorrhagic risk due to vascular–ectatic changes after surgery for gastriccarcinoid tumor is reported. She was refused forsurgical aortic valve replacement. Transfemoralimplantation of Edwards SAPIEN aortic valvewas indicated. On the day after implantation the patient stood up; she improved clinically as wellas objectively.Conclusions: Our case shows that there are additionaltherapeutic options for high-risk patientswith severe aortic stenosis. Transfemoralaortic valve implantation is a procedure thatdoes not require anaesthesia and thoracotomy. The implantation requires teamwork involvinginterventional cardiologist, cardio-vascularsurgeon and anaesthesiologist. The real clinicalvalue of the method is yet to be established asa result of ongoing clinical trials and in cooperationbetween interventional cardiologists andcardiac surgeons.
钙化主动脉瓣狭窄是西方世界最常见的瓣膜性心脏病。这是一种累及主动脉瓣的进行性、退行性、动脉粥样硬化样病变,随着人口年龄的增长,患病率越来越高。手术主动脉瓣置换术是严重症状性主动脉瓣狭窄患者的首选治疗方法,但在围手术期风险高的老年患者和有合并症的住院患者中存在局限性。经皮主动脉瓣植入术是近年来发展起来的一种新方法。它适用于围手术期风险高的有症状患者。病例报告:报告一例83岁女性类胃癌术后因血管扩张改变而出现严重症状性主动脉瓣狭窄及出血风险高的病例。她被拒绝进行主动脉瓣置换术。经股植入Edwards SAPIEN主动脉瓣。植入后第二天,患者站立;她在临床上和客观上都有所改善。结论:我们的病例表明,对于严重主动脉瓣狭窄的高危患者,有额外的治疗选择。经股主动脉瓣植入术不需要麻醉和开胸。植入需要介入心脏病专家、心血管外科医生和麻醉师的团队合作。该方法的真正临床价值还有待临床试验的结果以及介入心脏病专家和心脏外科医生之间的合作。
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引用次数: 0
Treatment of patients with comorbidity of substance use disorder and psychotic disorder. 物质使用障碍与精神障碍合并症患者的治疗。
Q4 Medicine Pub Date : 2010-07-01 DOI: 10.6016/320
N. Šegrec, A. Kastelic
The term dual diagnosis is used to describe thecomorbid condition of substance use disorderand other mental disorder. The prevalence ofsubstance use disorders is higher among patientswith other mental disorders than in general population.Regarding prognosis in the treatment ofpatients with comorbid disorders, both disordershave a poorer outcome when undertreated.There are four models explaining aetiology ofdual diagnosis: common factor models, secondarysubstance use disorder models, secondarypsychiatric disorder models and bidirectionalmodels.Differentiation between primary psychotic disordersthat co-occur with substance use and substanceinduced psychosis is generally difficult,but it is important for understanding the courseof illness and effective treatment planning. Threetreatment approaches are used in patients withcomorbid substance use disorder and anothermental disorder: parallel, sequentional and integrative–the last one supposed to be more effectivethan others. Therapeutic approaches in thetreatment of patients with dual diagnosis includepsychoeducation, motivational interventions,cognitive–behavioural therapy, social skillstraining and psycho-pharmacotherapy.
双重诊断一词用于描述物质使用障碍和其他精神障碍的合并症。物质使用障碍在其他精神障碍患者中的患病率高于一般人群。关于治疗合并疾病患者的预后,如果治疗不足,两种疾病的预后都较差。双重诊断的病因有四种模型:共同因素模型、二次物质使用障碍模型、二次精神障碍模型和双向模型。鉴别与物质使用共存的原发性精神障碍和物质诱发性精神病通常是困难的,但这对于了解疾病的过程和有效的治疗计划是重要的。有三种治疗方法用于同时患有物质使用障碍和其他障碍的患者:平行治疗、顺序治疗和综合治疗——最后一种治疗方法被认为比其他治疗方法更有效。双重诊断患者的治疗方法包括心理教育、动机干预、认知行为治疗、社会技能训练和心理药物治疗。
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引用次数: 0
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Zdravniski Vestnik-Slovenian Medical Journal
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