bluuebunny/crossref_metadata_2025 huggingface dataset:
Zgodnje prednosti manj invazivne transforaminalne zatrditve ledvene hrbtenice v primerjavi s klasično odprto metodo
Authors: Rečnik Gregor , Milčič Milko , Fokter Samo Karl , Mirnik Nino , Moličnik Andrej , Vogrin Matjaž
Published: November 2017

AbstractBackgroundLumbar interbody fusion is a standard operative procedure in orthopedic spine surgery. Morphological and functional changes in the multifidus muscle after an open procedure have led to the development of a minimally invasive technique, after which no such muscle changes were observed. MethodsSixty-four patients, with clinical and radiological criteria for one-level transforaminal lumbar interbody fusion were enrolled in our prospective randomized study between December 2011 and March 2014. They were randomized into two groups: open approach (33 patients) vs. minimally invasive approach (31 patients); one patient was excluded from each group due to postoperative complications. Independent samples T-test was used to compare average values of increase in creatin kinase (CK), which is an enzymatic marker of muscle injury, average surgical time, loss of blood during and after surgery, back pain according to the Visual Analogue Scale (VAS) and day of discharge from the hospital. ResultsStatistically important (P< 0.001) lower blood loss (188 ml vs. 527 ml total), less CK increase (15 ukat/L vs. 29 ukat/L), lower VAS score after surgery (7.3 vs. 8.7) and earlier discharge from the hospital (3.5 days vs. 5.2 days) were observed in the minimally invasive transforaminal lumbar interbody fusion group. No significant difference in average surgical time was recorded. Conclusions Our results suggest, that minimally invasive transforaminal lumbar interbody fusion causes is associated with less muscle damage, lower blood loss, less post surgical pain and faster early rehabilitation, which is in accordance with previous studies.
Zdravljenje odporne arterijske hipertenzije z renalno denervacijo – da ali ne?
Authors: Accetto Rok , Salobir Barbara , Kuhelj Dimitrij , Božič Nina
Published: November 2017

The true resistant hypertension is rare. The reasons are not entirely clear, but undoubtedly vegetative nervous system (renal afferent and efferent nerves) plays an important role. Surgical sympathectomy is effective but because of serious side effects is inappropriate. In recent years, a special catheter for endovascular renal radiofrequent denervation has been developed. With this method we have treated in accordance with the Slovenian and European recommendations, five patients with resistant hypertension. The radiofrequent ablation of renal arteries was not effective in our patients which is not what we expected because of  the results of the first two non-randomized uncontrolled studies - Simplicity HTN 1 and 2. The third in a series of international multicentre studies - a randomized, controlled, single-blind study Simplicity HTN 3 showed, however, that renal denervation is not effective method for the treatment of resistant hypertension. A detailed overview of enrolled patients suggests that certain patients may be eligible for intervention, but have not yet been identified.
TRIAŽA V URGENTNIH AMBULANTAH
Authors: Rajapakse Renata
Published: November 2017

This paper describes emergency triage. It presents the reasons for implementation of triage and its benefits. Focuses on the Manchester triage system, which is formally validated triage model in Slovenia.
POGOSTOST ZRAČNE EMBOLIJE IN POOPERATIVNI ZAPLETI PRI NEVROKIRURŠKIH POSEGIH V SEDEČEM POLOŽAJU Skrajšana verzija naslova: ZRAČNA EMBOLIJA PRI NEVROKIRURŠKIH POSEGIH V SEDEČEM POLOŽAJU
Authors: Spindler Vesel Alenka , Pirc Nina , Visočnik Božidar , Markovič - Božič Jasmina
Published: November 2017

Background: Posterior fossa surgery and cervical spine surgery are at risk for venous air embolism (VAE) occurrence. Mostly air emboli are small and asymptomatic, but invasion of large quantity of air in the circulation is symptomatic and potentially lethal. Transesophageal echocardiography is the most sensitive method for detection of air emboli in the heart, followed by the precordial Doppler probe, end tidal carbon dioxide monitoring (etCO2) and others.Methods: In our 14- years retrospective review we evaluated the incidence of VAE and postoperative complications in patients with posterior fossa surgery or cervical spine surgery. VAE was recognized by using Doppler probe and/or drop of etCO2. If VAE occurred, aspiration of air through the CVC was used to prevent or to minimized VAE occurrence, the surgeon was warned about the incident. VAE treatment was supportive.Results: VAE was recognized in 74 patients. Two patients after head surgery and four patients after neck surgery needed postoperative treatment in intensive care unit and controled mechanical ventilation. In six patients after head surgery and in four patients after neck surgery new neurological symptoms occurred. Two patients after head surgery died due to complications of massive VAE.Conclusions: VAE is rare, but serious complication of neurosurgery in sitting position. Preventive treatment, early detection of VAE, supportive treatment and treatment of cardiovascular complications are necessary for survival of patients with VAE.
Diagnostični protokol za obravnavo okuženih sklepnih vsadkov
Authors: Mlekuž Alen , Trebše Rihard , Mihalič Rene , Levašič Vesna
Published: November 2017

Infection is becoming the most important as well as the most devastating mechanism of prosthetic joint failure. The incidence is increasing due to increased sensitivity of orthopedic surgeons for this diagnosis, better diagnostics, and  because the absolute number of operated patients is increasing and because more often very sick, debilitated, and immunocompromised patients are operated on. The trend shows the incidence to further increase in the years to come. The diagnosis may be very easy in case of high grade processes, but also extremely difficult in low grade infections. Misdiagnosing infection leads to repeat early failures and revisions that are distressing for patients as well as for surgeons. To avoid failures related to misdiagnosed prosthetic joint infections a step-wise algorithm of action is proposed and the diagnostic strength of the steps discussed. The key point is to select the potential candidates to define the possibility of an ongoing infection and then to select the tools to strengthen the suspicion. The further procedures base on the analysis of the pseudo-synovial fluid obtained by aspiration. The diagnostic conclusions form the basis for considered treatment decisions.
Iz naših arhivov – prva perkutana koronarna revaskularizacija pri bolniku z akutnim miokardnim infarktom pred 26 leti. Prikaz kliničnega primera.
Authors: Kranjec Igor , Pavčnik Dušan
Published: November 2017

A clinical case of a patient that suffered from an acute myocardial infarction with ST-segment elevation (STEMI) 26 years ago is presented. Systemic thrombolysis was not possible due to the recent bleeding from the duodenal ulcer. Therefore, the urgent percutaneous coronary revascularization, the first such procedure in Slovenia, was successfully carried out. The PCI was successful, the hospital course uneventful, and the patient did not experience any symptoms for the next two years. Unfortunately, the coronary atherosclerosis progressed later due to unsatisfactory secondary prevention measures; however, the treated infarct-related artery remained patent. The authors explain the strategy of the performed percutaneous procedure and discuss the further development of the treatment. Eleven years later, the primary PCI developed into the dominant reperfusion strategy of the STEMI in Slovenia.
NOSEČNOST V JAJČNIKU PO PREDHODNO ZDRAVLJENI ISTOSTRANSKI TUBARNI NOSEČNOSTI PRI ŽENSKI V IVF-ET POSTOPKU ZARADI NEPLODNOSTI
Authors: Bizjak Neda , Klanjšček Jure
Published: November 2017

Ovarian pregnancy is a rare condition. In article we report a case of ovarian pregnancy in a 42-years old woman who had already undergone an ipsylateral tubectomy because of an extrauterine pregnancy.Even though the patient showed no symptoms, the inadequate rise of β hCG and the ultrasound scan were suspicious for an ovarian pregnancy which was later confirmed, intrapoeratively as well as patohistologically.Some repeated values of β hCG did not show enough rise up and vaginal echography revealed atypical anechoic mass placed on or in the right ovary. The anechoic mass seen at right ovary become more and more tipical for gestational sac.In combination with the fact, that the uterine cavity was empty, without echo-signs of  intrauterine pregnancy and becouse of her past experiance of extrauterine pregnancy, we soon decided to perform a diagnostic laparoscopy, which confirmed our suspicion. Gestational sac was laparoscopicaly removed.The ovary and ovarian tube on her left side were normal and without any changes of chronical inflamatory disease.
MOTENA GIBLJIVOST GLASILK - DIAGNOSTIČNI POSTOPKI IN ZDRAVLJENJE 2. del
Authors: Pintarić Karlo , Hočevar Boltežar Irena
Published: November 2017

Paresis or paralysis of one or both vocal cords affects phonation, swallowing and breathing. The major cause for reduced mobility or even immobility is innervation damage, less often mechanical disorder.The main procedures in the diagnostics of disordered vocal fold mobility are indirect laryngoscopy and videoendostroboscopy. Different imaging techniques (especially computerized tomography) are of great value in searching for a cause of the impaired mobility.In unilateral vocal fold immobility, the treatment is focused on the improvement of voice quality and the prevention of aspiration during swallowing. In bilateral paralysis, it is crucial to find a balance between effective breathing and sufficient voice quality. The treatment of unilateral paralysis is started with voice therapy and swallowing rehabilitation. If these procedures are not enough surgical treatment for the medialization of the paralyzed vocal fold is applied. In the case of breathing difficulties in bilateral vocal fold immobility there is a possibility of surgical lateralization of one or both folds or a surgical excision of a part or the entire vocal fold. Surgical reinnervation, functional electrostimulation of certain laryngeal muscles and gene therapy are developing treatment modalities.
Kakovost življenja pred in po laparoskopski resekciji črevesa zaradi globoke infiltrativne endometrioze
Authors: Vujanović Aleksandra , Ribič-Pucelj Martina , Jelenc Franc
Published: November 2017

Background: Te purpose of the study was to determine the quality of life in patients with bowel endometriosis before and afer laparoscopic bowel resection.Material and methods: In the retrospective study we included 91 patients who underwent laparoscopic resection of the bowel aﬀected by endometriosis at the Unit for Reproduction and the Unit for Gynecology, Department of Obstetrics and Gynecology Ljubljana, in the period from 2002 to 2011. Te study was retrospective. Te patients were sent a questionnaire regarding the symptoms before surgery and the eﬀect of surgery on bowel symptoms, painful menstruation, painful sexual intercourse, chronic pelvic pain and quality of life before and afer surgery; 76 (83.5 %) patients replied to the questionnaire.Results: Before surgery, 72 (94.7 %) patients reported painful menstruation. Improvement or complete relief afer surgery was registered in 57 (79.1 %). Out of 60 (78.9 %) patients who had painful sexual intercourse before surgery, 49 (81.7 %) reported improvement or complete relief afer surgery. Bowel symptoms, present in 52 (68.4 %) patients before surgery, improved or completely disappeared in 48 (92.4 %) afer surgery. Chronic pelvic pain, present in 53 (69.7 %) before surgery, decreased or did not exist any more in 45 patients (86.5 %). Te quality of life before surgery was very poor in 32 patients (42.1 %), and poor in 21 patients (27.8 %). Afer the operation, the quality of life was reported as improved in 22 (28.9 %) and signifcantly improved in 42 (55.3 %).Conclusions: Laparoscopic bowel resection, indicated in extensive symptomatic endometriosis, signifcantly improves the patients’ quality of life.
Presejanje nosečnic za Streptococcus agalactiae – ali moramo narediti naslednji korak?
Authors: Jeverica Samo , Kotnik Eva , Lučovnik Miha , Tul Mandić Nataša
Published: November 2017

AbstractBackground: Streptococcus agalactiae is the leading infectious cause of morbidity among neonates. Majority of early onset neonatal infections can be prevented using antimicrobial prophylaxis during labour. Different diagnostic procedures can be employed to detect maternal colonization during pregnancy and labour. In the present study we analysed diagnostic characteristics of two common methods for detection of S. agalactiae.Methods: One hundred and one consecutive vaginal or combined vaginal-rectal swabs were included in this prospective study. All samples were tested with enrichment culture and molecular illumigene GBS assay. Results of repeatedly disconcordant samples were retested and confirmed with a different molecular assay. Sensitivity, specificity, positive and negative predicted values were determined for both assays.Results: Mean age of women was 33 years. Prevalence of colonisation in the sample was 23,8 %. Positivity rates using enrichment culture only, illumigene GBS assay only and combination of both assays were 19,8 %, 22,7 % and 23,8 %, respectively. Sensitivity, specificity, positive and negative predictive values were 83,3 %, 100 %, 100 % in 95,1 % for enrichment culture and 95,8 %, 100 %, 100 % in 98,7 % for illumigene GBS assay, respectively. Combining both methods 20 % more colonized women were detected compared to enrichment culture alone.Conclusions: With a combination of enrichment culture and illumigene GBS assay we can detect substantially more colonized women compared to currently most frequently used method of enrichment culture. Comprehensive evaluation of current strategies for prevention of S. agalactiae early neonatal infection is warranted in Slovenia.
Metastatski tumorji hipofize: predstavitev treh primerov in pregled literature
Authors: Šmigoc Tomaž , Velnar Tomaž , Kšela Urša , Ravnik Maja , Lanišnik Boštjan , Bunc Gorazd , Ravnik Janez
Published: November 2017

Background. Metastatic tumours to pituitary are rare. The most frequent are metastases from breast and lung.Methods. In this paper, three cases of metastatic tumours to the pituitary are presented with panhypopituitarism as a common symptom: I) a 60-year-old gentleman with metastasis of diffuse large B cell lymphoma, who presented with diabetes insipidus, II) a 54-year-old lady with metastatic renal clear cell carcinoma and consequent disturbances in visual acuity, brain nerve paresis and III) a 57-year-old lady with breast cancer metastasis, visual impairment and brain nerve paresis.Results. A transnasal endoscopic resection of the tumours was performed in all cases, followed by oncological treatment. All patients improved after the treatment.Conclusions. Despite the rarity of the disease, a metastatic tumour to the pituitary gland must be included in the differential diagnosis when symptoms such as diabetes insipidus, ophthalmoplegy due to brain nerve palsies, rapid course of the disease and headache are observed. In 20% to 30%, pituitary metastases are the first manifestation of a tumour of unknown origin. Surgical and adjuvant therapy may improve the quality of life. The survival and prognosis are generally poor.
Možnosti zdravljenja napredovale Parkinsonove bolezni
Authors: Flisar Dušan , Zupančič Križnar Nina , Trošt Maja , Pirtošek Zvezdan
Published: November 2017

Advanced stage of Parkinson's disease is associated with motor complications: motor fluctuations and dyskinesias. The disease can no longer be satisfactorily treated with oral therapy that is based on treatment with levodopa. Dying of dopamine neurons, a short half-life of levodopa and pulsatile stimulation of dopamine receptors are the main reasons for these complications. Currently, there are three options available to treat the advanced stage of Parkinson's disease: subcutaneous infusion of apomorphine, intrajejunal infusion of levodopa and deep brain stimulation. It is necessary to choose the optimal method of treatment that is most suitable for the individual patient.
ETIOLOŠKI DEJAVNIKI ZA NASTANEK POLIPA NA GLASILKAH
Authors: GLUVAJIĆ DAŠA , HOČEVAR BOLTEŽAR IRENA
Published: November 2017

Background: Vocal fold polyp is one of the most common causes for hoarseness. Many different etiological factors contribute to vocal fold polyp formation. The aim of the study was to find out whether the etiological factors for polyp formation have changed in the last 30 years.Methods: Eighty-one patients with unilateral vocal fold polyp were included in the study. A control group was composed of 50 volunteers without voice problems who matched the patients by age and gender. The data about etiological factors and the findings of phoniatric examination were obtained from the patients' medical documentation and from the questionnaires for the control group. The incidence of etiological factors was compared between the two groups. The program SPSS, Version 18 was used for statistical analysis.Results: The most frequent etiological factors were occupational voice load, GER, allergy and smoking. In 79% of patients 2 – 6 contemporary acting risk factors were found. Occupational voice load (p=0,018) and GER (p=0,004) were significantly more frequent in the patients than in the controls. The other factors did not significantly influence the polyp formation.Conclusions: There are several factors involved simultaneously in the formation of vocal fold polyps both nowadays and 30 years ago. Some of the most common factors remain the same (voice load, smoking), others are new (GER, allergy), which is probably due to the different lifestyle and working conditions than 30 years ago. Occupational voice load and GER were significantly more frequently present in the patients with polyp than in the control group. Regarding the given results it is important to instruct workers with professional vocal load about etiological factors for vocal fold polyp formation.
Pot do ustanovitve Slovenija-transplanta
Authors: Svetina Nastja , Zupanič Slavec Zvonka
Published: November 2017

Transplantation medicine is a rather young medical field. As a method of treatment human organs are used. These organs are donated with the aim to help fellow humans plagued by disease or in desperate situation. First condition for a successful treatment is developing a program that will take care of procuring the necessary organs. This should be an independent activity which requires appropriate addressing of professional, juridical, organizational and ethical aspects.In 1970, Slovenia started kidney transplantation from living related donors. As long as the transplantation activity covered only kidney transplants of the living donors, all the activities were conducted by nephrologists. Act on removal and transplantation of human body parts for medical purposes issued in 1985, and Rules on detailed medical criteria and the methods for determining occurrence of brain death of the person from whom it is permitted to take body parts for transplantation for treatment in 1986, made it possible to transplant organs from deceased donors. With the transition to deceased donor organs and the possibility of transplanting other organs (heart, liver, lungs, pancreas), it became necessary to organize these activities on national level. In 1992 Extended expert council for transplantation was established. The council planned all the necessary procedures for the construction of National transplantation network, the establishment of 24-hour coordination and the fastest way of passing of a transplantation law which enabled the establishment of Slovenia-transplant in 2000.After the establishment of 24-hour central coordination the number of organs procured from deceased donors has increased substantially. Slovenia has reached a similar number of organs obtained from deceased donors per million inhabitants, as member countries of the Eurotransplant association. At the same time the system was safe, reliable, transparent and properly regulated. Slovenia could therefore start negotiations for joining Eurotransplant. Even before the formal establishment of Slovenija Transplant, Slovenia became full member of the association.
Otroška paraliza – pozabljena bolezen? Otroška paraliza na Stari Gori
Authors: Schincariol Michele , Savić Jasna , Zupanič Slavec Zvonka
Published: November 2017

The following  review article describes poliomyelitis and the management of children after the disease  at the Hospital of Stara Gora in the years 1952–1962. The precious experiences of the experts, who treated patients with poliomyelitis and of physicians, who were affected by it, are a credible proof of the seriousness of the disease and of the need to keep a high vaccination rate in our society.
NAČRTOVAN POROD NA DOMU: PREGLEDNI ČLANEK
Authors: Serdinšek Tamara , Takač Iztok
Published: November 2017

Background: Home birth is as old as humanity, but still most middle- and high-income countries consider hospitals as the safest birth settings, as complications regarding birth are highly unpredictable. Despite this there are a few countries in which home birth in integrated into official healthcare system (the Netherlands, United Kingdom, Canada etc.). Home births can be divided into unplanned and planned, and the latter can be further categorized by the presence of the birth attendants. This review focuses on planned home births, which are differently represented throughout the world. In the United States 0.6-1.0% of all children are born at home, in the United Kingdom 2-3%, in Canada 1.6% and in the Netherlands 20-30%. For Slovenia, the number of planned home births is unknown; however, in 2010 0.1% of children were born outside medical facilities.Conclusions: The safety of home birth in still under the debate. While research confirms smaller number of obstetric interventions and some complications in mothers who give birth at home, the data regarding the neonatal and perinatal mortality and morbidity is still conflicting. This confirms the need for large multicentric trials in this field. Current home birth guidelines emphasize that women should be well informed regarding the possible advantages and disadvantages of home births. In addition, the emphasis is on definition of selection criteria for home birth, indications for intrapartal transfer to the hospital and appropriate education of birth attendants.
Bolnišnična obravnava in preživetje bolnikov in bolnic s srčnomišičnim infarktom, zdravljenih s perkutano koronarno intervencijo: analiza po spolu
Authors: Kanič Vojko , Sinkovič Andreja
Published: November 2017

AbstractBackgroundSex-differences in presentation and outcomes of ischemic heart disease are well known. Data about gender related mortality comparing men and women after acute coronary syndrome (ACS) and percutaneous coronary intervention (PCI) is conflicting and sparse. The aim of the study was to establish the possible association between gender and in-hospital mortality after ACS treated with PCI in our region.MethodsACS patients (3624) undergoing PCI were analyzed. In-hospital mortality was observed in women and men in different age groups.ResultsIn-hospital mortality was higher among women than in men (5.1% in men vs. 9.3% in women; p<0.0001). Women more than 80 years old died more frequently in-hospital than their male counterparts (21.2% vs.11.8; p=0.01). The same trend was observed in women aged 50-59. Gender did not predict in-hospital mortality.ConclusionWomen's in-hospital mortality is higher than in men. Women older than 80 years die more often as their age-matched male patients. Special attention should be paid to women with ACS since they are older, with more comorbidities, and therefore, high risk.
Etične vrednote kot temelj človekovega ravnanja
Authors: Ošlaj Borut
Published: November 2017

Introductory lecture at the expert workshop entitled »Etics at the Crossroads« heldwithin the 152nd regular annual assembly of the Slovenian Medical Association inMoravske Toplice
Priporočila za odkrivanje in zdravljenje bolezni prsne aorte
Authors: Štalc Monika , Blinc Aleš , Kozak Matija , Kuhelj Dimitrij , Ključevšek Tomaž , Štajer Dušan , Koželj Mirta , Gasparini Mladen , Žuran Ivan , Flis Vojko , Lakić Nikola , Klokočovnik Tomislav
Published: November 2017

*NO ABSTRACT
A patient with diplopia and upper eyelid edema: a case report
Authors: Šivec Trampuž Igor , Kosec Dragica
Published: November 2017

Idiopathic orbital inﬂammatory disease, previously referred to as orbital pseudotumor, is a nonneoplastic, non-infective disease. The inﬂammatory process can involve one or more orbital sof tissues; extraocular muscles, tear gland, scleralorepiscleral tissue or orbital fat. Orbital myositis typically presents itself with a sudden onset of restricted ocular motility, diplopia, congestive proptosis, eyelid ptosis, periocular swelling and conjunctival hyperemia. A thorough workup is essential for ruling out other entities.This report presents a case of a 47-year old man with a sudden onset of right upper eyelid swelling and diplopia. Until then he had no health problems. Afer initial ophthalmologic workup and ultrasound an orbital mass was suspected. Te MRI and a biopsy of the mass confirmed an isolated superior oblique muscle myositis. We treated him with systemic steroids. A good response and fast regression were observed. In two years of follow-up visits no recurrence was noted.Isolated superior oblique muscle myositis is extremely rare. This is one of eleven cases documented between 1988 and 2015. This case report presents a 47-year old man with a sudden onset of right upper eyelid swelling and diplopia. Until then he had no health problems. After initial ophthalmologic workup and ultrasound an orbital mass was suspected. The MRI and a biopsy of the mass confirmed an isolated superior oblique muscle myositis. We treated him with systemic steroids. A good response and fast regression was observed. In two years of follow-up visits no recurrence was noted.Isolated superior oblique muscle myositis is extremely rare. This is one of eleven documented cases between 1988 and 2015.
Državna zaščita vojnih invalidov na slovenskem po 1. svetovni vojni
Authors: Omejec Janja , Zupanič Slavec Zvonka
Published: November 2017

War invalids, war widows and their dependent family members were permanent victims of war. The First World War brought great changes in organized care and treatment of war invalids. At the first post-war census of the Yugoslav population in 1921, Slovenia recorded around 11,500 people with disabilities and about 31,000 war widows with about 50,000 dependent family members. The census was conducted by a professional service within the Ministry for Social Policy.The large increase of the number of war invalids demanded more effective care for them, as they represented not only a material but also a moral and political problem for the country. A more recent disability legislation expanded the rights of war invalids and significantly improved their economic and social status and provided them with various benefits. Above all, the country expanded the rehabilitation of persons with disabilities, implemented occupational therapy and trained them for different work, including work in production among other areas. An increasing number of institutions were built that had adopted the disabled into permanent care.
Association between alcohol abuse, childhood adverse events and suicide
Authors: Politakis Vida Ana , Pregelj Peter , Videtič Paska Alja , Zupanc Tomaž
Published: November 2017

Background: Negative life events present a risk for suicidal behaviour. The occurrence of suicidal behaviour also depends on type of negative life events, time of their appearance and the support person has in their environment, and can be part of a process triggered by a stressful event. the aim of the study was to investigate adverse childhood events, parental alcoholism and alcohol abuse in association with suicidal behaviour of suicide victims.Methods: A case-control study was conducted involving 90 individuals from Slovenian population who committed suicide and 90 age-sex matched controls drawn from the living population. Data were collected by means of semi-structured interviews with key informants by the principles of psychological autopsy.Results: Alcohol abuse was reported more ofen for suicide victims than for controls. The same was true for severe deprivation in childhood and alcoholism of one or both parents. Diﬀerences between groups in separation from one or both parents, death of one or both parents, reported parental divorce in childhood or sexual abuse in childhood were not observed.Conclusions: We should conclude that negative events in childhood and alcohol abuse in adulthood of suicide victims could be related to suicidal behaviour in population with higher suicide rate. When planning measures for the prevention of suicidal behaviour, adverse events in childhood and alcohol abuse should not be neglected to plan measures to prevent such events accordingly and to raise awareness about the dangers of alcohol abuse for suicidal behaviour.
Strokovno stališče Društva travmatologov Slovenije o zdravljenju zlomov medenice pri osteoporozi
Authors: Brilej Drago , Krušič Dejan , Kristan Anže , Cimerman Matej , Čretnik Andrej , Trebše Rihard , Kocjan Tomaž , Grabljevec Klemen , Komadina Radko
Published: November 2017

Because of the ageing crisis in western world the fragility fractures of the pelvic ring joint the big four group of typical fractures in osteoporotic elderly patients: fractures of the proximal femur, fractures of the proximal humerus, fractures of the distal radius and thoracic and lumbar low energy spinal fractures. All these fractures are the result of low energy with the typical fall of the patient from the standing height. The Slovenian recommendations include Rommens classification for non-displaced and displaced fractures of the anterial and posterial pelvic ring with the operative indications. The recommendations were launched at the Slovenian society of trauma surgeons meeting in November 7th, 2015.
DIAGNOSTIKA, ZDRAVLJENJE IN SPREMLJANJE ODRASLEGA BOLNIKA Z INTERMEDIARNIM UVEITISOM
Authors: Počkar Saša , Valentinčič Nataša Vidović
Published: November 2017

Intermediate uveitis is a chronic inflammatory eye disease where the vitreous is the major site of the inflammation. It mostly affects younger patients. The inflammation can be idiopathic or related to either infectious or autoimmune systemic disease. The leading cause of visual deterioration in intermediate uveitis is cystoid macular edema and cataract is the most common complication.Criteria for treating intermediate uveitis depend on the cause of the disease. We consider the presence of cystoid macular edema, vitreous haze 2+ or more, retinal neovascularization or vasculitis. We decide to treat the patient early, because it is easier to preserve visual function and ocular structures. The basic approach to treatment is a »step approach«. We start the treatment  with periocular, intraocular or systemic corticosteroids. If the treatment is ineffective we use immunosuppressants/immunomodulators. Prognosis is improved with  early control of inflammation and early treatment of the complications.
Spolne motnje in njihova obravnava po načelih spolne medicine
Authors: Simetinger Gabrijela
Published: November 2017

Sexual Medicine is a discipline concerned with the impact of psychophysiology, relationships, socio-cultural influences, developmental effects, sexual preference and variations, gender identity and inter-gender differences on the sexual function and experience of men and women of all ages, both as individuals and within the context of their relationships. Its aim is the restoration or improvement of function, and the optimisation of sexual experience and well-being, and of personal and interpersonal satisfaction with sexuality. According to sexual medicine, sexual problems are divided into four categories: sexual concerns, difficulties, dysfunctions and disorders.Two linear (Masters and Johnson, Kaplan) and a circular model (Basson) are the three most commonly used models of sexual response in sexual medicine. According to the latest sexuality studies a new classification has been introduced by the International Committee of Sexual Medicine. Sexual dysfunctions are not divided into physical or psychogenic anymore; the cause should be clarified through the etiology. A biopsychosocial approach, which systematically considers biomedical, psychological and socio-cultural history, is used in the assessment of a sexual problem. The basic modelling system of psychosexual therapy is the PLISSIT model.A biopsychosocial approach was used on 127 women with a sexual dysfunction, average age 34.3 (from 19 to 64), treated at the gynaecological outpatient clinic in General hospital Novo mesto between 2013 and 2015. In addition, the PLISSIT model proved to be simple and successful.
Vaskularni kognitivni upad in vaskularna demenca
Authors: Ovčar Klavdija , Potočnik Jure , Rakuša Martin
Published: November 2017

In the developed world, five to ten percent of people older than 65 years have dementia. One fifth of dementia etiologies are due to vascular brain lesions (VaD – vascular dementia). A milder form is called vascular cognitive impairment (VCI). The main clinical criteria for VaD are: 1. cognitive decline verified with standardized cognitive test/scale, 2. evidence of the associated vascular brain lesion, 3. excluded reversible causes of cognitive decline. The main risk factors for VaD are age, atherosclerosis, diabetes and hypertension. They play a key role in pathogenesis of the cognitive impairment. Depending on the damaged brain region, different cognitive domains may be affected with or without other neurological signs. These diversities in the clinical picture challenge the correct diagnosis. Unique feature of VaD is its progression, which can be stopped, if patients receive an appropriate treatment.The treatment of VCI and VaD symptoms is similar to that in Alzheimer’s disease. More importantly, VCI may be slowed down or even stopped with proper secondary stroke prevention and good rehabilitation. The most efficient is primary stroke prevention with healthy lifestyle and treatment of acquired risk factors.
Spremenjena aktivnost encima 5,10-metilentetrahidrofolat reduktaze (MTHFR) vpliva na razvoj številnih bolezni
Authors: Vidmar Maša , Grželj Jasna , Gersak Ksenija , Mlinarič-Raščan Irena
Published: November 2017

The importance of folates in human physiology is well known, as are various pathologies associated with low folate status. Folate deficiency can occur due to low dietary intake, genetic predisposition or treatment with medicines affecting the folate status. The aim of this paper is to explore the importance of determining genetic polymorphisms which influence the levels of biologically active folate. MTHFR is involved in the transformation of 5,10-methylene-THF to 5-methyl-THF. Polymorphisms of the MTHRF gene are associated with decreased enzymatic activity.Only 9.3 % of the population in Slovenia displays full activity of the MTHFR enzyme; these subjects are non-mutated homozygotes (wild-type alleles). In contrast, the average enzymatic activity in subjects with mutated alleles is between 50 and 60 %. MTHFR polymorphism is associated with an increased risk of hyperhomocysteinemia and cardiovascular diseases, neurological disorders and various types of cancer. There is also an increased risk for congenital malformations. Folic acid food fortification was introduced in some countries in order to assure an adequate folate status in the population. However, this approach does not address the decreased activity of MTHFR.Polymorphism in the key enzymes of the folate cycle is common. Determination of the genetic predisposition is therefore plausible in the most vulnerable groups of the population, such as pregnant women and patients receiving medicines influencing the folate cycle in various ways, e.g. 5-fluorouracil, methotrexate and 6-mercaptopurine. Genotyping would allow the identification of patients at high risk for suboptimal folate status.
Zdravljenje diseminiranega plazmocitoma na Kliničnem oddelku za hematologijo UKC Ljubljana z avtologno presaditvijo krvotvornih matičnih celic v letih 2014 in 2015.
Authors: Zver Samo , Melkić Enver , Radevska Tanja
Published: November 2017

Introduction. In the period from 01.01.2014 to 31.12.2015 at Clinical Department of Hematology, University Medical Centre Ljubljana, we treated 73 multiple myeloma patients with first autologous  hematopoietic stem cell transplantation (HSCT).Methods and results. Age of patients ranged from 27 to 72 years with the median age of 60 years. Induction treatment at the time of diagnosis consisted of: VD (bortezomib, dexamethasone) 60/73 patients (82%), VCD (bortezomib, cyclophosphamide, dexamethasone)  10/73  patients (14%) and VTD (bortezomib, thalidomide, dexamethasone) 3/73 (5%)  patients. As part of induction therapy, patients received from 1 to 9 cycles of treatment. Response to induction therapy prior to HSC(hematopoietic stem cells) collection was as follows: CR(complete remission )7/73(10%), VGPR (very good partial response) 28/73(38%), PR (partial response) 23/ 73(32%), SD (stable disease) 11/73(15%) andPD (progressive disease) 4/73(5%) patients. Response to induction therapy immediately prior to autologous HSCT: CR9/73 (12%), VGPR32/73 (44%), PR17/73(23%), SD 8/73(11%) and PD6/73(8%) patients. Response to induction therapy and the first autologous HSCT at D+100 after HSCT: CR9/67 (13%), VGPR 34/67 (51%), PR 12/67 (18%), SD 3/67 (4 %) and PD 7/67 (10%) patients (in 6 patients data are missing, because they are not mature yet).  With single HSCT 63 patients were treated, while 10 patients received double or second HSCT. The overall mortality of patients treated during the  period from 01.01.2014 to 31.12. 2015 was 6/73 or 8.2%.Conclusions. The treatment of multiple myeloma with autologous HSCT remains the cornerstone of efficiency,as demonstrated by the increasing share of the most desired responses to treatment, ie. CR and VGPR. The treatment mortality rate was within expectation limits.
Laparoskopska radikalna histerektomija z limfadenektomijo: naše izkušnje
Authors: Meglič Leon
Published: November 2017

BackgroundThe second most common cancer in women up to 65 years of age is cervical cancer. Same cancer is the leading cause of death from gynaecological deseases worldwide.The standard procedure for cervical cancer treatment with FIGO stage including  IB2 is radical hysterectomy sec. Wertheim-Meigs-Novak with or without adnexa with radical pelvic lymphadenectomy and/or para-aortic lymphadenectomy. In the last two decades has with the development of laparoscopy also developed  laparoscopic radical hysterectomy .Laparoscopic radical hysterectomy with pelvic and para-aortic lymph nodes dissection was performed for the first time by Nezhat with coworkers in 1989.Laparoscopic radical hysterectomy with pelvic and/or paraaortic lymphnode dissection in treatement of cervical cancer including FIGO stage IB1 is performed at Dep Ob/Gyn UKC Ljubljana since 2013. The purpose of this article is to evaluate the morbidity and safety of the procedure. MethodsWe retrospectively reviewed the medical records of patients with cervical cancer who underwent laparoscopic radical histerectomy with pelvic and/or paraaortic lymphadenectomy from April 2013 to May 2016. Results34 patient were included, 32 patients with CC FIGO stage IB1, 1 patient with CC FIGO stage IB2, 1 patient with CC FIGO stage IIB.There were four (11,8%) bladder lesions, all of them were corrected during the surgery, but no ureteral lesion! There was one (2,9%) surgical revision right after the surgery due to assumption of bleeding (though there was no active bleeding found).Three patients (8,8%) had permanent urinary dysfunction – retention. One patient (2,9%) had dehiscence of vaginal vault after 4 months (after sexual intercourse)There was no ureterovaginal/vesicovaginl fistula after surgery! The mean operating time was 2 hours 55 min, mean admission time after surgery was 8,7 days, mean blood loss during operation was 291 ml. ConclusionsLaparoscopic radical hysterectomy is the method of choice in cervical tumors including FIGO stage IB1.Percentage of bladder lesions is part of learning curve.Our goal in future is to decrease  the percentage of bladder lesions and to decrease the percentage of patients suffering from bladder dysfunction by using „nerve sparing“ technic.We expect, the same results for 5 year survival rate as with patients treated with classical radical hysterectomy.
Določanje velikosti in vstavitvene trajektorije pedikularnih vijakov v računalniškotomografskih (CT) slikah deformacij prsne hrbtenice: primerjava ročnega in računalniško podprtega predoperacijskega načrtovanja
Authors: Knez Dejan , Mohar Janez , Cirman Robert Janez , Likar Boštjan , Pernuš Franjo , Vrtovec Tomaž
Published: November 2017

Background: Vertebral fixation by pedicle screw placement is the most frequently applied fixation technique in spinal surgery. In this retrospective study we present a comparison of manual and computer-assisted preoperative planning of pedicle screw placement in three-dimensional (3D) computed tomography (CT) images of deformities in the thoracic spine.Methods: Manual planning of the pedicle screw size and trajectory was performed by two orthopedic surgeons using a dedicated software for preoperative planning of surgical procedures, while computer-assisted planning was performed by automated image processing and analysis techniques through the optimization of screw fastening strength. The size (diameter and length) and trajectory (pedicle crossing point, inclination in the sagittal plane, inclination in the axial plane) were obtained for 316 pedicle screws from 3D CT images of 17 patients with thoracic spinal deformities.Results: the analysis of pedicle screw parameters, obtained by two manual and one computer-assisted planning, indicated a statistically significant diﬀerence in the screw size (p < 0.05) and trajectory (p < 0.001). Computer-assisted planning proposed wider (p < 0.05) and longer (p < 0.001) screws with a higher (p < 0.001) normalized fastening strength.Conclusions: The comparison revealed consistency between manual and computer-assisted planning of the pedicle screw size and trajectory, except for the screw inclination in the sagittal plane, as manual planning followed more the straight-forward while computer-assisted planning followed more the anatomical insertion technique. While being faster, more repeatable and more reliable than manual planning, computer-assisted planning was also linked with a higher screw fastening strength and consequently a higher screw pull-out strength.
Amelioration of iodine supply is notably associated with thyroid function in healthy subjects and in patients with euthyroid Hashimoto’s thyroiditis
Authors: Novak Nadja , Biček Ajda , Zaletel Katja , Gaberšček Simona
Published: November 2017

Background: Our aim was to establish how healthy subjects (HS) and patients with euthyroid Hashimoto's thyroiditis (EuHT) faced the increase in mandatory salt iodization in Slovenia in 1999 from previous 10 mg of potassium iodide to 25 mg per kg since data about thyroid function with respect to iodine supply are scant.Methods: In this retrospective study we reviewed records of 24,899 patients referred for the first time between 1995 and 2002 to our tertiary referral centre with a stable catchment area for more than 20 years. HS were negative and patients with EuHT positive for thyroid peroxidase antibodies and/or thyroglobulin antibodies. Thyrotropin (TSH), free thyroxine (fT4), and free triiodothyronine (fT3) levels were obtained. The fT4/fT3 ratio was calculated.Results: In the period 1995-1998, 917 HS had significantly lower fT4/fT3 ratio than 644 HS in the period 1999-2002 (2.6±0.6 and 2.9±0.9, respectively, p<0.001) on account of significantly higher fT3 (median 5.7 and 5.2 pmol/L, p<0.001). Similarly, in 1995-1998, 482 patients with EuHT had a lower fT4/fT3 ratio than 846 EuHT in 1999-2002 (2.4±0.6 and 2.8±0.7, respectively, p<0.001) on account of significantly higher fT3 (median 5.8 and 4.9, respectively, p=0.018). HS had a higher fT4/fT3 ratio than patients with EuHT in 1995-1998 but not in 1999-2002 (p<0.001 and p=0.206, respectively).Conclusions: Amelioration of iodine supply is associated with an increase in the fT4/fT3 ratio on account of lower fT3, and with a similar thyroid function in HS and in patients with EuHT.
Anteriorna plagiocefalija – Prikaz primera in opis kirurške tehnike
Authors: Spazzapan Peter , Bošnjak Roman , Velnar Tomaž , Cassisi Antonino
Published: November 2017

Anterior plagiocephaly is a result of premature unilateral fusion of the coronary suture. It is the third most common form of non-syndromic craniosynostoses. Its main features include forehead, supraorbital arch and anterior cranial fossa deformation as well as orbital asymmetry. Te treatment is surgical. Te main aim is to relieve compressed brain tissue and achieve an acceptable aesthetic eﬀect. We describe a boy with anterior plagiocephaly, who has undergone an extensive craniofacial reconstruction.
Vpliv amiodarona na delovanje ščitnice – Prikaz primera
Authors: Verček Gregor , Malej Andrej , Jugovac Nives , Gregorič Edvina
Published: November 2017

Amiodarone is an antiarrhythmic drug, commonly used in the treatment of ventricular and supraventricular arrhythmias. It can cause many side eﬀects, including thyroid dysfunction, which can lead to either hypo- or hyperthyroidism. There are two types of amiodarone-induced hyperthyroidism. Type 1 aﬀects patients with preexisting thyroid pathology and is the consequence of iodine excess. Type 2 is not related to preexisting thyroid pathology and is characterised by the presence of destructive thyroid inﬂammation.A 55-year old male was admitted to our hospital because of chest pain. He was diagnosed with atrial fibrillation and three vessel coronary artery disease, serum TSH concentration was normal. The patient later underwent coronary artery bypass surgery and was subsequently prescribed amiodarone. Two years later he became hyperthyroid, thyroid ultrasonography was consistent with autoimmune thyroid disease, however thyroid autoantibodies were negative. Amiodarone was discontinued and antithyroid drugs were introduced, leading to remission of hyperthyroidism. One month after the discontinuation of the antithyroid drugs the patient had a primary cardiac arrest, there were signs of diﬀuse ischemic cerebral injury. Due to nonsustained ventricular tachycardias an implantable cardioverter defibrillator was inserted, the patient was again prescribed amiodarone, and after three years of continuous amiodarone treatment hyperthyroidism recurred. As amiodarone discontinuation in conjunction with antithyroid drugs and high-dose glucocorticoid treatment did not result in remission, total thyroidectomy was safely performed. Pathohistological examination of the thyroid revealed pathologic changes consistent with amiodarone-induced hyperthyroidism type 2. Substitution therapy with levothyroxine was introduced on the 17th postoperative day.Peroral glucocorticoid therapy is the first line treatment of type 2 amiodarone-induced hyperthyroidism. However, in a selected group of patients, where medication therapy is unsuccessful, total thyroidectomy is an eﬀective and safe modality, despite high-dose glucocorticoid treatment and other possible comorbidities. Furthermore, total thyroidectomy makes continuous amiodarone therapy possible, when it is necessary. It is important to keep in mind that high serum concentrations of free triiodothyronine and free thyroxine may persist for several days after total thyroidectomy.