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SMJERNICE IZ KARDIOPULMONALNE REANIMACIJE EUROPSKOG VIJEĆA ZA REANIMATOLOGIJU 2005.
EUROPEAN RESUSCITATION COUNCIL GUIDELINES FOR RESUSCITATION 2005
Descriptors: Cardiopulmonary resuscitation – standards, methods; Electric countershock – standards, methods; Heart arrest – therapy; Advanced cardiac life support; Practice guidelines
Summary. European Resuscitation Council guidelines for resuscitation 2005 summary: Adult basic life support – The ratio of compressions to ventilations is 30:2 for all adult victims of cardiac arrest. Automated external defibrillation – A single defibrillatory shock is delivered, immediately followed by two minutes of uninterrupted CPR. Adult advanced life support – In out-of-hospital cardiac arrest attended, but unwitnessed, by healthcare professionals equipped with manual defibrillators, give CPR for 2 minutes before defibrillation. The recommended initial energy for biphasic defibrillators is 150–200 J, for second and subsequent shocks is 150–360 J. The recommended energy when using a monophasic defibrillator is 360 J for both the initial and subsequent shocks. Rhythm checks must be brief, and pulse cheks undertaken only if an or- ganised rhythm is observed. Adrenaline is given 1 mg i.v. as soon as intravenous access is obtained, and repeated every 3–5 min thereafter until return of spontaneous circulation is achieved. Consider thrombolytic therapy when cardiac arrest is thought to be due to proven or suspected pulmonary embolus. Unconscious adult patinets, with spontaneous circulation, after out-of-hospital VF cardiac arrest should be cooled to 32–34°C for 12–24 hours. Paediatric basic life support – Lay rescuers or lone rescuers witnessing paediatric cardiac arrest will start with 5 rescue breaths and continue with the 30:2 ratio as thaught in adult BLS. Two or more rescuers with a duty to respond will use the 15:2 ration in a child up to the onset of puberty. Paediatric advanced life support – When using a manual defibrillator, a dose of 4 J/kg (biphasic or monophasic waveform) should be used for the first and subsequent shocks. Adrenaline iv. or i.o. should be given at the dose of 10 μg/kg (0.01 mg/kg) and repeated every 3–5 minutes. Neonatal life support – Protect the newborn from heat loss. Standard resusci- tation in delivery room should be made with 100% oxygen. Suctioning meconium from the baby’s nose and mouth before delivery of the baby’s chest (intrapartum suctioning) is not useful and no longer recommended.
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KORELACIJE TJELESNE VISINE I TEŽINE DJECE PRI UPISU U 1. RAZRED OSNOVNE ŠKOLE I POKAZATELJA RASTA DJECE PRI ROĐENJU S TJELESNOM VISINOM RODITELJA
CORRELATION BETWEEN CHILDREN’S WEIGHT AND HEIGHT AT MEDICAL EXAMINATION ON ENROLLING IN 1st CLASS OF PRIMARY SCHOOL AND BIRTH GROWTH PARAMETERS WITH PARENTAL HEIGHTS
Descriptors: Body weight; Body height; Child development; War; Stress disorders, post-traumatic – psychology
Summary. Physical growth is permanently influenced by genetic and environmental factors. Their impacts are overlapping, and therefore it is difficult to separate the contribution particularly ascribable to one or another kind of the factors. The study investigated the relation between body weight and height in 397 children (195 girls and 202 boys) enrolling primary school and their birth growth features on the one side, and their parents’ heights on the other. The correlations between children’s weight and height on enrolling primary school and their birth growth features were also studied. The aim was to examine the proportion of genetic determinacy of children’s growth. Mean birth weight and length were 3440±413 g and 50.50±2.00 cm, respectively, and mean head circumference was 34.50±1.20 cm. On entering the primary school, the children were 6.70±0.30 years of age in average, and had mean body weight and height of 24.60±5.00 kg and 122.70±6.15 cm, respec- tively. Majority of children had both parents with middle or low education level, 285 (71.79%) of them. Majority of children also had both parents employed. 266 (67.00%) of them. Children’s height on enrolling the school was in significant positive correlation with birth weight, length and head circumference, and with parents’ heights. The correlation coefficient was the highest with father’s height (r=0.473, p<0.01), and the lowest with birth weight (r=0.158, p<0.05). Children’s weight on enrolling the school significantly positively correlated with the three birth growth features and with father’s height, but not with mother’s height (r=0.091, p>0.05). The correlation coefficient was the highest for father’s height (r=0.288, p<0.01) again. All the birth parameters correlated stronger with mother’s than with father’s height. In the subgroup of children whose mothers were of equal or greater height than fathers (n=28), correlation coefficient between children’s and fathers’ heights (r=0.295, p<0.01) was lower than between children’s and mothers’ heights (r=0.474, p<0.01). In conclusion, children’s weight and height at the time of enrolling primary school significantly positively correlates with their parents’ heights. The correlations are stronger with father’s height. Though, it is not the matter of gender, but of the higher parent. The birth growth parameters are only in part related to parents’ heights (all three with mother’s and only one with father’s height). It is obvious that mothers’ influence is dominant for children’s growth at that time. There was no significant difference in any examined parameter between subgroups of children divided according to their parents education level and employment status.
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NEPREPOZNATI PARAGANGLIOM STRAŽNJEG MEDIJASTINUMA – ANESTEZIOLOŠKI RIZIK
UNSUSPECTED POSTERIOR MEDIASTINAL PARAGANGLIOMA – ANESTHETIC RISK
Descriptors: Paraganglioma – surgery, physiopathology; Mediastinal neoplasms – surgery, physiopathology; Anesthesia, general; Intraoperative complications
Summary. A 70-year old female patient was admitted to the hospital because of scheduled thoracotomy and biopsy of poste- rior mediastinal retrocardiac tumor of unrecognized etiology. The patient had no complaints regarding the tumor. Routine anesthesiological preoperative examination revealed status ASA III. Induction in anesthesia was usually stable. At the moment when the surgeon intraoperatively touched the tumor, hemodinamic instability started and arterial blood pressure and heart rate dramatically increased. Our first reaction was to deepen the anesthesia. Very soon it was obvious that blood pressure increased by the surgeon’s manipulation of the tumor and we started to doubt on catecholamine-secreting tumor. During the course of the operation there were several hypertensive episodes and we managed them by alternately using atenolol, glyceroltrinitrate and anesthetic drug. The patient was extubated 5 hours after transfer to the intensive care unit. Postoperative period was hemodynamically stable. The level of catecholamines in 24-hour urine collection was significantly increased. Pathohistologic diagnosis was mediastinal paraganglioma.
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INTRAHIOIDNA CISTA DUKTUSA TIROGLOSUSA
THYROGLOSSAL DUCT CYST IN HYOID BONE
Descriptors: Thyroglossal cyst – diagnosis, surgery; Hyiod bone – pathology, surgery
Summary. The thyreoglossal cyst may be located in the intralingual, suprahyoid, thyrohyoid or suprasternal region. Its position in the hyoid bone is extremely rare. In this paper a 62-year-old patient with a big thyreoglossal duct cyst situated in the corps of the hyoid bone is described. Besides a painless solid swelling in the medial neck region, the patient had swallowing and breathing problems, which is unspecific for thyreoglossal duct cyst. By removing the hyoid bone with thyreoglossal duct cyst, the patient’s problems completely disappeared and during 1 year long observation no sickness relapse has been noted.
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KOMPLEMENTARNE METODE VOĐENJA PORODA
COMPLEMENTARY DELIVERY METHODS
Descriptors: Delivery, obstetric – methods
Summary. Complementary methods in obstetrics are related to humanization of delivery and woman’s decision on the mode of delivery in normal labor. The methods include various birthing positions, aids such as delivery chair, birthing wheel, etc., and water delivery. Results of recent studies comparing these methods with classic delivery in supine position are presented. The advantages of these alternative methods of delivery include shorter duration of delivery, reduced need of labor induction, lower use of analgesics, and women’s acceptance of these methods of delivery with the same level of mater- nal and neonatal safety as in classic delivery. All these advantages apply to water delivery providing the prerequisities, con- traindications and measures of surveillance are strictly met.
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FULVESTRANT: NOVI LIJEK U HORMONSKOJ TERAPIJI RAKA DOJKE
FULVESTRANT: A NEW AGENT IN ENDOCRINE TREATMENT FOR BREAST CANCER
Descriptors: Breast neoplasms – drug therapy; Antineoplastic agents, hormonal – therapeutic use; Estradiol – analogs and derivatives, therapeutic use; Selective estrogen receptor modulators – therapeutic use
Summary. Tamoxifen is considered to be the gold standard in hormonotherapy of patients with estrogen dependent breast cancer (estrogen receptor (ER) and/or progesterone receptor (PR) positive tumors). However, because tamoxifen’s benefi- cial effects diminish after 5 years of use in adjuvant setting and because of its partial agonistic effects and its resistence to tamoxifen in some breast carcinoma, there is a need for new antiestrogens. One of these antiestrogens is fulvestrant which, unlike tamoxifen, has no partial agonistic effects. Its efficacy has been confirmed in preclinical and in recent phase III clini- cal studies in postmenopausal patients. In disease recurrence after adjuvant tamoxifen or progressive disease on-first-line tamoxifen treatment fulvestrant is comparable with (similar to) anastrozole. When compared with tamoxifen as first-line treatment in patients with advanced cancer, only in patients with ER and/or PR positive tumors similar results have also been obtained. In both trials tolerance to fulvestrant has been good. Following the results of these clinical studies fulvestrant has already been licenced in the USA and EU for the treatment of postmenopausal women with advanced breast cancer who had progressed on prior anti-estrogen therapy.
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RITUKSIMAB U LIJEČENJU B-STANIČNIH NE-HODGKINOVIH LIMFOMA
RITUXIMAB IN THE TREATMENT OF B-CELL NON-HODGKIN LYMPHOMA
Descriptors: Lymphoma, Non-Hodgkin – drug therapy; Lymphoma, B-cell – drug therapy;
Antibodies, monoclonal – therapeutic use, administration and dosage;
Antineoplastic agents – therapeutic use, administration and dosage; Antigens, CD20 – immunology
Summary. Rituximab, a chimeric anti-CD20 monoclonal antibody, has become a part of standard treatment of B-cell non-Hodgkin lymphoma in the last several years. Depleting CD20+ cells by various mechanisms, it is active as a single agent and particularly when combined with chemotherapy. It is effective in »in vivo« elimination of neoplastic cells from the hematopoetic stem cell transplant. Side-effects are mostly infusion related, mild to moderate, mediated by cytokine release. Because of different mechanisms of action, adding rituximab to chemotherapy does not cause additional toxicity. Combination of rituximab and chemotherapy improves response rates in indolent lymphomas and survival in aggressive lymphomas.
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OSOBITOSTI SKUPLJANJA AUTOLOGNIH KRVOTVORNIH MATIČNIH STANICA IZ PERIFERNE KRVI U PEDIJATRIJSKIH BOLESNIKA
AUTOLOGOUS PERIPHERAL BLOOD STEM CELL COLLECTION IN PEDIATRIC PATIENTS
Descriptors: Peripheral blood stem cell transplantation – methods; Leukapheresis – methods, adverse effects; Hematopoietic stem cell mobilization – methods; Transplantation, autologous; Child
Summary. Autologous peripheral blood stem cells are increasingly used for transplantation instead of bone marrow, even in small children and adolescents. We analyzed 73 autologous leukaphereses performed in 25 children (36% males, 64% females). The median age was 15 years (range 3–18) and the median body weight 48 kg (range 16 –67). The apheresis proce- dures were carried out with cell separator COBE Spectra. Each patient underwent a median of 2 collections (range 1–6). The median total nucleated cell yield was 11.86×108/kg (range 1.94–21.21), mononuclear cell yield was 6.01×108/kg (range 0.97–12.73) and CD34+ cell yield was 3.5×106/kg (range 0.19–28.01). During 6 (8.22%) procedures the patients had experi- enced apheresis-related side effects. The citrate-induced reactions were most commonly observed. The reactions were mild and cessation of collection was required only in one case, because of catheter related complication. Our results show that leukapheresis in pediatric patients is a safe procedure, well tolerated and with a very low risk of serious adverse events.
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UPALNE BOLESTI CRIJEVA I TRUDNOĆA
INFLAMMATORY BOWEL DISEASE AND PREGNANCY
Descriptors: Inflammatory bowel diseases – drug therapy; Pregnancy complications – drug therapy; Pregnancy outcome
Summary. Inflammatory bowel diseases (IBD) can affect women of childbearing potential. There are many issues to con- sider in female patients with IBD who are contemplating pregnancy, such as influence of the disease on fertility or pregnancy outcome, effect of the gestation on the course of the disease, safety of the drugs and inheritance of the disease in the off- spring. It is important to remember that the outcome of the pregnancy is dependent mostly on the activity of the disease at the time of conception and there is no increase of the adverse events in patients with quiescent bowel disease. With few excep- tions, majority of medications used in the treatment of IBD are safely used during pregnancy and breastfeeding. This article reviews the most recent knowledge regarding the effects of IBD and their treatment on fertility and pregnancy, therapeutic options and outcomes in patients who are planning pregnancy or who are pregnant or lactating.
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PSIHOLOŠKA ISTRAŽIVANJA O PRIRODI EKSPERTNOG ZNANJA
NATURE OF EXPERT KNOWLEDGE – PSYCHOLOGICAL RESEARCH
Descriptors: Professional competence; Problem solving; Decision making
Summary. The nature of expert knowledge is explored from two points of view. One of them questions the possibility of expert judgement making in practice and analyses the possible origins of bias of professional decision making. The second approach assumes that expertise manifests in different approaches in solving problems between beginners and experts who have proven high competence in the field. Shanteau’s analysis of particular fields of expertise which shows differences in validity and reliability of professional decision making was also described. These differences to large extent can be attrib- uted to different characteristics of problems specific to a particular field. In The last section of the paper gives an overview of the research results considering the origins of bias in medical expertise.
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