bluuebunny/crossref_metadata_2025 huggingface dataset:
Primer uspešnega timskega pristopa zdravljenja izzvane vulvodinije
Authors: Simetinger Gabrijela , Šćepanović Darija
Published: November 2017

AbstractBackground: Vulvodynia has been defined as vulvar discomfort, most often described as burning pain, occurring in the absence of relevant findings or a specific, clinically identifiable, neurologic disorder. Vulvodynia is a genital syndrome of multi-causal origin and requires a team approach. The purpose of the case report of provoked vulvodynia is to show the efficacy of individualized, multifaceted and multidisciplinary therapeutic team approach used by a gynaecologist with special knowledge of sexology and a physiotherapist specialising in treatment of pelvic floor dysfunction. Case report: A 35-year old patient presented with a complaint of genital itching and consequently burning pain which first occurred during sexual intercourse one year previously. Afterwards a gynaecologist with special knowledge of sexology performed a biopsychosocial assessment, broader gynaecological examination and psychoeducation. Diagnosed was provoked vulvodynia. Than she was assessed by the physiotherapist specialising in treatment of pelvic floor dysfunction and treated with TENS. To assess the effectiveness of treatment were used Female Sexual Function Index questionnaire and the visual analogue scale before and after the team approach treatment. Conclusions: In our case individualized, multifaceted and multidisciplinary therapeutic approach proved to be a good choice for treating genital syndrome of provoked vulvodynia of multi-causal origin.
Celostna obravnava novorojenčka in dojenčka z okvaro brahialnega pleteža – predlog slovenskih smernic
Authors: Groleger Sršen Katja , Repež Andrej , Zorman Peter , Fister Petja , Štucin Gantar Irena , Paro Panjan Darja , Kržan Matevž
Published: November 2017

The impairment of brachial plexus (IBP) in the neonate and infant remains an important problem. Risk factors for IBP are well known, but the mechanisms of impairment are not yet fully understood. It is important to identify early signs of IBP and to evaluate the hand function. In the guidelines we propose to use the Toronto scale for evaluation of hand function. The newborn with IBP should be referred to physiotherapy, and then regularly followed-up once a month. If the arm and hand function, especially flexion of the elbow, is not improving at the age of two months, the infant should be referred to the tertiary level rehabilitation centre and to department for plastic surgery at the University Medical Centre in Ljubljana. When necessary, the reconstructive procedure should be done by the age of three to six months. After reconstruction of brachial plexus, the child needs a comprehensive therapy program, which involves passive stretching, sensory stimulation, exercises to promote the development of active voluntary movements, bimanual activities, and symmetrical posture and movement patterns.
Bilateral Dysfunction of Superior Laryngeal Nerves as a consequence of Cervical Necrotising Fasciitis: A case report
Authors: Šifrer Robert , Fošnarič Iztok , Rainer Katja , Urbančič Jure , Grošelj Aleš , Žargi Miha
Published: November 2017

Background. Cervical necrotizing fasciitis is an infectious disease with serious complications and grave prognosis. We report a case of the cervical necrotizing fasciitis with consequent bilateral dysfunction of superior laryngeal nerves and describe the characteristics of this exceptional complication.Case report. A 71-year-old female patient, surgically treated for cervical necrotizing fasciitis, suffered from severe dysphagia after surgery. Radiographic and fiberendoscopic evaluation showed aspiration and hyposensibility of glottis and supraglottis. Apart from inadequate laryngeal elevation, we explain the dysphagia also by the sensory deficit of the supraglottic mucosa with consequent lack of vocal folds adduction during swallowing. The sensory deficit was attributed to the toxic neuritis-mediated dysfunction of both internal branches of superior laryngeal nerves. The healing of both cervical necrotizing fasciitis and toxic neuritis led to the restoration of sensory function and the swallowing.Conclusions. Although only occasionally reported in the literature, the patients with cervical necrotizing fasciitis are prone to toxic neuritis-mediated neurologic deficits of cranial nerves. They are considered to be another complication of this entity.
Ruptura sprednje kite golenske mišice – pregled literature in prikaz kliničnega primera rekonstrukcije s kito semitendinozne mišice pri pacientu s sladkorno boleznijo in polinevropatijo
Authors: Frangež Igor , Krašna Matevž , Nizič-Kos Tea , Smrke Dragica Maja
Published: November 2017

Abstract:Background: Rupture of the tibialis anterior tendon is a rare injury. It can be traumatic or spontaneous. Spontaneous rupture is usually a consequence of degenerative changes of the tendon caused by accompanied diseases. For successful treatment and rehabilitation early diagnosis is mandatory. For diagnosis a clinical examination is most important and ultrasound examination and/or magnetic resonance additionally confirms the diagnosis. Treatment can be operative or conservative with below knee non-weight bearing cast. Conservative treatment is usually decided where ruptures are older than three months, especially in patients with poorer mobility or with accompanied diseases. In the literature there are several techniques considering surgical treatment.Case report: A 56 years old men with diabetes mellitus and polyneuropathy sustained a rupture of the tibialis anterior tendon at injury walking downhill. Rupture was at first unrecognized and was treated as an ankle sprain.  After two months he was reexamined and a rupture of the tibialis anterior tendon was diagnosed and surgically reconstructed using semitendinosus tendon graft. Conclusion: Rupture of the anterior tendon of tibialis muscle was reconstructed by using an autologous graft of semitendinosus muscle tendon, in which we achieved good long-term results. Tendon of semitendinosus is suitable because it has properties similar to anterior tendon of tibialis muscle. Because of the similar diameters it is also suitable for bridging of longer defects, such as in our case.
Preprečevanje venskih trombembolij pri ginekoloških operacijah
Authors: Pakiž Maja , Bizjak Tina , Vene Nina , Bizjak Bojana
Published: November 2017

Venous thromboembolism (deep vein thrombosis, pulmonary embolism) are serious, but highly preventable complications associated with gynecologic surgery. Risk of thromboembolic complications depends on patient characteristics, type and duration of surgery. Beside adequate hydration, according to the risk stratification we recommend thromboprophlaxis with mechanical methods and antithrombotic drugs (usually low molecular weight heparins). In this article current guidelines for effective and safe thromboprophlaxis for gynecological surgery are presented.
Kakovost odmrznjenih pripravkov krvotvornih matičnih celic za presaditev
Authors: Krašna Metka , Maličev Elvira , Jež Mojca , Nunar Perko Andreja , Cukjati Marko
Published: November 2017

Background:The appropriate dose of compatible and viable hematopoietic progenitor cells (HPC) is crucial for successful engraftment of transplanted cells within patients. In the study we therefore checked the viability of HPC in thawed HPC grafts which were transplanted into haematology patients in one year. Methods:We acquired HPC by apheresis and froze them in a programmable freezer in autologous plasma with 10 % DMSO and stored them in liquid nitrogen vapour. We thawed the bags with HPC in a water bath at the patient's bedside and in the eluate residues from the bags after the addition of saline solution we determined the viability (7-AAD) of HPC (CD34 +) and lymphocytes by flow cytometry.Results:After the transplantation of HPC, the viability of HPC was 79.9 ± 12.4 % and of leukocytes 62.2 ± 12.2 % (paired t-test, P < 0.001) in cell suspension residues (n = 88). The average viability of HPC in samples which were frozen immediately after collection (n = 58) was 79.9 ± 9.2 % and in samples frozen the next day after 18 hours in the fridge, the viability was 80.5 ± 11.3 % (n = 67). Storing samples overnight did not significantly affect the viability of cells in comparison with samples which were frozen immediately (t-test, P > 0.5). Rinsing of HPC bags and storing cells after thawing in saline solution significantly (n = 7; paired t-test, P <0.01) increased the mortality of HPC, since the viability immediately after thawing was 84.1 ± 4.5 % and in samples diluted with saline solution 60.1 ± 15.7 %.Conclusions:In our laboratory, cca 20 % of HPC are lost during freezing and thawing of HPC grafts. Freezing HPC grafts 18 hours after cell collection does not affect the viability of thawed cells in comparison with grafts which are frozen immediately. Saline solution is not suitable for rinsing bags and storing HPC residuals after thawing HPC products.
Progesteron za preprečevanje prezgodnjega poroda
Authors: Lucovnik Miha , Premru Sršen Tanja
Published: November 2017

Background: Progesterone is important in maintaining pregnancy. Progesterone supplementation may reduce risk of preterm birth in certain populations of pregnant women. The objective of this review was to develop evidence-based clinical recommendation for progesterone treatment in the prevention of preterm birth.Methods: A search in the Medline database was performed using keywords: progesterone, pregnancy, preterm birth, preterm labour, preterm delivery, randomized trial, and randomized controlled trial. We only included studies of vaginal progesterone treatments for the prevention of preterm birth and excluded studies on 17-α-hydroksiprogesterone caproate.Results: We report findings from twelve randomized trials conducted since 2003. These trials differ regarding inclusion criteria, progesterone dose, vehicle used, and duration of treatment. Inclusion criteria were: short uterine cervix (two trials), history of previous preterm birth (two trials), signs and symptoms of preterm labour (three trials), twin pregnancies (three trials), and multiple risk factors (among these history of previous preterm birth was the most common) (two trials). Six of these twelve trials showed a significant reduction in preterm birth in the progesterone groups.Conclusions: Based on current evidence we recommend treatment with 200 mg of micronized progesterone daily, administered vaginally, in pregnant women found to have a short cervix (≤ 25 mm) at 19-24 weeks. The treatment should be continued until 37 weeks.
Jacobsenov sindrom
Authors: Treiber Milena , Dukić Vuković Tanja , Kropivšek Veronika
Published: November 2017

Jacobsen syndrome is a gene syndrome caused by partial deletion of the long arm of chromosome 11.About 20% of children die during the first two years of life, most commonly realated to complications from congenital heart disease, less commonly from bleeding.The authors present a male newborn that inhereted unbalanced deletion from a carrier mother.
PREGLED NAJPOGOSTEJŠIH NAPRAVILNOSTI V IZVIDU KRVNE SLIKE V URGENTNIH AMBULANTAH IN PREPOZNAVA URGENTNIH STANJ
Authors: Cvejić Vidali Gaja , Zver Samo , Podgornik Helena
Published: November 2017

Complete blood count is basic investigation in medicine. It gives us necessary information for acutely sick patient's diagnostic and treatment. We describe the most frequent etiology of red, white and thrombocyte cell lines abnormalities and give notice on conditions who require immediate measures.We had analyzed 1297 complete blood count results of patients who sought medical help in Emergency setting of Ljubljana's health care center from 1.1. 2014 to 31.1. 2014.Every fourth patient treated in the emergency setting had abnormalities in complete blood count. The most frequent finding was leucocytosis, following normocyte anemia and erytrocite's morphological abnormalities without laboratory signs of anemia. Every tenth patient had abnormalities in two or three cell lines.Complete blood count is probably the most basic investigation in medicine. From the results we can suspect on many different pathologies. Differential blood count should be ordered if we find abnormalities in complete blood count. Physicians should read and evaluate complete blood count with the same dedication as we read electrocardiogram.
SMERNICE ZA PERIOPERATIVNO ZDRAVLJENJE S TEKOČINAMI (GUIDELINES FOR PERIOPERATIVE FLUID TREATMENT)
Authors: Spindler Vesel Alenka , Požar Lukanović Neva , Berger Jelena , Vlahović Dušan , Gradišek Primož , Novak-Janković Vesna
Published: November 2017

Introduction.The maintainaning of optimal perioperative fluid and electrolyte balance in the perioparative period (before, during and after an operation) is a crucial for anaesthesia and intensive therapy. Fluid treatment interferes with the metabolism and functioning of all organ systems, therefore it is important that the patient gets the right type and quantity of fluid at the right time. Perioperative fluid therapy should be guided by the patient’s condition and type of the operation procedure. In fluid therapy, one should take into consideration the need for fluid maintenance (basal metabolism needs), preoperative fluid loss correction (e.c. duration of preoperative starving, especially in children), and aim for good tissue perfusion with an adequate fluid load. The final goal of fluid replacement is to maintain fluid and electrolyte balance, intravascular volume and consequently cardiovascular stability (adequate cardiac output), organ perfusion and tissue oxygenation. Before, during and after surgery balanced fluids should be used, in order to minimise disturbances to the electrolyte balance. In our article, literature of perioperative fluid replacement is reviewed. The results of the latest research have provoked a lot of criticism and disagreement about colloids. Only guidelines about crystalloid application are presented.Conclusions. The latest guidelines for perioperative fluid therapy emphasise the application of balanced intravenous fluids that minimise electrolyte and acid base balance disturbances. It is important to individualise the amount of the intravenous fluid to avoid hyper- or hypovolemia. The correct choice of the type of solution is equally important as any other medication that influences the patient’s outcome.
Rib cage deformity during two-stage tissue expander breast reconstruction in patient with previous radiotherapy: a case report
Authors: Porčnik Aleš , Ahčan Uroš
Published: November 2017

Patients undergoing two-stage breast reconstruction with tissue expander and a history of previous irradiation are predisposed to a various chest-wall deformations more than non-irradiated patients. If chest-wall depression with/without rib fracture is found intra-operatively, bigger implant should be used, with a subsequent radiologic evaluation. In the future, the development of a new, modified expander with a harder base could minimise such complications.
Multisistemska vnetna bolezen z začetkom pri novorojenčku (MVBN): Prikaz primera
Authors: Berden Urška , Toplak Nataša , Debeljak Maruša , Avčin Tadej
Published: November 2017

Neonatal onset multisystem inflammatory disease is a rare autoinflammatory disorder. Clinical features include fever episodes, urticarial rash, arthralgia and arthritis, eyes and central nervous system involvement. It belongs to the group of cryopyrin-associated periodic syndromes which  result from a gain-of-function mutations of the NLRP3 gene on chromosome 1p44 that encodes the cryopyrin protein. Defects lead to overproduction of inflammatory cytokines involved in the innate immune system, especially interleukin 1.This article reports a clinical case of a 6-year-old boy, who presented with  first clinical signs of the disease soon after birth. We present a diagnostic approach in a case of suspected periodic fever syndrome. It is based on exclusion of infections, primary immunodeficiencies, autoimmune and malignant disorders. For confirmation of the disease, genetic analysis is mandatory. The patient was successfuly treated with biological medications which block interleukin 1.
Izolirana ekstremitetna perfuzija
Authors: Kuhar Sandra , Hočevar Marko
Published: November 2017

Isolated limb perfusion is a surgical procedure that can be used to treat an advanced malignant melanoma and soft tissue sarcomas, it is also effective in treating in-transit metastases of melanoma and local metastases of soft tissue sarcomas. With perfusion of the affected limb with cytostatic agents it is possible to avoid amputation and mutilating operations that significantly reduced the function of the limb. Since the procedure is isolated on a limb, it can be perfused with much higher doses of cytotoxic drugs, systemic toxicity is thus reduced or prevented. The most common side effects are erythema and edema.Cytotoxic drugs, that are manly used, are melphalan and tumor necrosis factor alpha. Efficient also proved to be simultaneous hyperthermia of the affected limb.
Prevalenca kolonizacije z bakterijo Streptococcus agalactiae pri nosečnicah v Sloveniji, 2013-2014
Authors: Lučovnik Miha , Tul Mandić Nataša , Lozar Krivec Jana , Dolinar Urša , Jeverica Samo
Published: November 2017

AbstractBackground: Streptococcus agalactiae is the leading cause of preventable invasive neonatal infections. Detection of maternal colonisation and use of antimicrobial prophylaxis during labour is a standard preventative approach. Very few data about the prevalence of colonisation with S. agalactiae among pregnant women in Slovenia are available.Methods: We performed a retrospective study of consecutive samples from pregnant women screened for S. agalactiae colonisation with enrichment culture during the period 2013-2014. Basic demographic data, specimen type, timing and result of the assay were analysed. Cumulative antimicrobial susceptibility for the positive samples was calculated.  Results: During 2 years study period 1564 pregnant women were tested. Mean age 31 years (18-46 years). Among samples received, majority were vaginal swabs 57,0 % (n=893). Recommended combined vaginal-rectal swabs were received in 12,9 % (n=192). Overall prevalence of maternal colonisation was 17,1 % (n=268) and did not differ with regard to specimen type. Resistance or reduced susceptibility to erythromycin and clindamycin was 23,1 % (n=62) and 20,9 % (n=56), respectively. No resistance to penicillin and vancomycin was detected.Conclusions: Few pregnant women get screened for S. agalactiae in Slovenia. Nevertheless, high colonisation rate was detected on a large sample size. Most samples were taken during the proposed period between 35-37 week of pregnancy. Recommended combined vaginal-rectal were less frequently taken for screening than vaginal swabs only. Penicillin and vancomycin remains universally active against S. agalactiae. However, erythromycin and clindamycin resistance was high.
Fluoroless cryo-ablation of para-Hisian accessory pathway
Authors: Prolič Kalinšek Tine , Jan Matevž , Geršak Borut , Jug Jure
Published: November 2017

We present a case of para-Hisian accessory pathway ablation in a patient with Wolﬀ-Parkinson-White syndrome, which was performed with cryoablation to reduce the possibility of collateral damage to the conduction system of the heart. We also used ﬂuoroless approach to exclude possible harm from radiation exposure, using only intracardial electrograms and three-dimensional (3D) electro-anatomic mapping system to navigate the catheters in the heart.
PAROKSIZMALNA NOČNA HEMOGLOBINURIJA - PRIPOROČILA ZA ODKRIVANJE BOLEZNI TER PREGLED POPULACIJE BOLNIKOV V SLOVENIJI
Authors: Hauptman Jasmina , Žontar Darja , Preložnik Zupan Irena
Published: November 2017

Background: Paroxysmal nocturnal hemoglobinuria (PNH) is a rare, acquired disease associated with hemolytic anemia, bone marrow failure, thrombosis, and, frequently, poor quality of life. It is caused by defects in the membrane of blood cells, where there is a lack of protein on the cell surface, which inhibits complement activation. We wanted to know the recognition of the disease in Slovenia and the incidence. We prepared the recommendations for discovering of the disease. Patients and methods: We collected data of 68 patients with prospective analysis of one – year period from 1.10.2013 to 30.9.2014 whose blood was sent to the laboratory of immunology and cytology because of suspected presence of PNH clone. The analysis of peripheral blood was performed with multiparametric high specific flow cytometry in a specialized laboratory KO of Haematology University Medical Centre in Ljubljana. Results: PNH clone was positive in 13/68 (19%) patients, 55/68 (81%) patients had a negative PNH clone, most positive samples were sent from the University Medical Centre Ljubljana (7/13). 4/13 positive patients were newly discovered. In average the incidence through 10-years was 1,3 / 1,000,000 population/year. The most common cause of PNH patient referral to a specialist hematologist was unexplained cytopenia - 12/13 (92.3%), the most common symptoms were fatigue and dyspnea (100%), in 2/13 patients was present dark urine with hemoglobinuria, 2/13 patients had transient renal insufficiency. 11/13 patients with positive PNH clone had associated a bone marrow failure (aplastic anemia or myelodysplastic syndrome).  The size of PNH clone varied from patient to patient. Conclusions: Early identification of PNH is a key to effective treatment and survival of patients. We recommend determining PNH clone at Coombs negative hemolytic anemia, hemoglobinuria, an unexplained cytopenia, aplastic anemia, myelodysplastic syndrome with laboratory evidence of haemolysis and unexplained thrombosis.
ZDRAVLJENJE OKUŽB ROŽENICE S PREČNIM POVEZOVANJEM KOLAGENIH VLAKEN
Authors: Štabuc Šilih Mirna
Published: November 2017

Corneal collagen cross-linking increases the stability of the cornea through the use of the photosensitive material - riboflavin (vitamin B2) and ultraviolet A radiation. Progressive keratoconus is the most common indication and the frequency of these procedures is increasing worldwide. As cross-links in the cornea are a physiological principle of all connective tissue, additional indications were proposed. These include postrefractive surgery ectasia, bullous keratopathy, and, infectious keratitis.Infectious keratitis can lead to blindness without proper antimicrobial therapy. But even prompt initial management, with appropriate antimicrobial treatment, can be subjected to microorganism sensitivity and resistance.This article presents current data regarding the use of corneal collagen cross-linking in the treatment of corneal infections. This treatment modality may become important, but unanswered questions remain. Larger, prospective comparative studies should give the answers.
Perinatal analgesia and labour outcomes in Slovenia: a retrospective analysis of births between 2003 and 2013
Authors: Bergant Jernej , Sirc Tina , Lučovnik Miha , Verdenik Ivan , Stopar Pintarič Tatjana
Published: November 2017

Background: Effective labour analgesia is important for the mother and the newborn although it might have adverse effects on the labour outcome. Due to our limited data, the slovene obstetricians, when counselling prospective mothers, mainly rely on foreign data the findings of which are difficult to interpret because of differences in labour management between countries. The aim of this retrospective analysis is to evaluate the effects of labour analgesia on the obstetric outcome in slovene maternity units.Methods: A retrospective study using data from the National perinatal information system was done, and 168863 deliveries were analysed. All singletons (cefalic presentation and gestational age of 37 weeks 0/7 and more) from all 14 Slovenian maternity wards, born from 1st Jan 2003 to 31th Dec 2012 were included. Stillbirths, children with congenital abnormalities and elective caesarean sections were excluded. Univariate analysis and multivariate logistic regression were used to examine the impact of risk factors on birth outcomes.Results: Multivariate logistic regression showed that epidural and intravenous analgesia compared to the absence of analgesia present a higer risk factor for labour duration above 7 hours (OR 5.1; 95 % CI 4.8–5.4 for epidural analgesia), (OR 1.8; 95 % CI 1.8–1.9 for intravenous analgesia) and for vacuum extraction of the fetus (OR 4.0; 95 % CI 3.7–4.4 for epidural analgesia), (OR 1.7; 95 % CI 1.6–1.8 for intravenous analgesia). Only epidural analgesia increases the risk for occipitoposterior presentation (OR 1.8; 95 % CI 1.7–2.0). The risk for caesarean section decreases with intravenous (OR 0.4; 95 % CI 0.4–0.5) as well as with epidural analgesia (OR 0.6; 95 % CI 0.5–0.6). Neither intravenous nor epidural analgesia incure any risk factor for low Apgar score (< 6) (OR 1.0; 95 % CI 0.8–1.1 for intravenous analgesia) (OR 0.9; 95 % CI 0.7–1.2 for epidural analgesia) or pathological cardiotocogram (OR 1.0; 95 % CI 0.9–1.0 for intravenous analgesia) (OR 1.0; 95 % CI 0.9–1.1 for epidural analgesia).Conclusions: Intravenous and epidural analgesia affected the course and outcome of labour. Mothers under epidural anagesia had a higher risk of labour longer than 7 hours, incidence of occipitoposterior presentation and vaccum extraction of fetus. Pain control during labour reduced the risk of caesarean section and had no adverse effects on the neonate.
Uporaba zdravil in dojenje v poporodnem obdobju v Sloveniji
Authors: Krajec Maja , Natek Neva , Geršak Ksenija
Published: November 2017

Background: To date there are no known data about the use and administration of medicine in the postpartum period in Slovenia.Methods: We included 1,070 women after they gave birth in a prospective cross-sectional study while they were routinely admitted to the Maternal and Neonatal Unit of the Department of Perinatology at the University Medical Centre Ljubljana’s, from October 2011 to February 2012. Data were collected through written questionnaires and finally statistically analysed. The same questionnaires were given at time points of  3, 6, and 12 months after giving birth.Results: Three days after giving birth 96.5% of women were breastfeeding fully or partially. The most commonly used medications during this period were analgetics, laxatives and iron supplements. In the period of up to 3 months after giving birth, 84.0% of women were breastfeeding fully or partially, whereas the number decreased to 72.4% in the period from 3 to 6 months after giving birth. Analgetics, vitamins and/or minerals and folic acid supplements were the most used medications in both periods. From 6 to 12 months after giving birth 51.5% of women were breastfeeding. Vaginally administered antimycotics were most commonly used medicines in this time period in addition to analgetics, vitamins and/or mineral supplements.Conclusions: No significant difference could be determined in the frequency of medicine use in all three time periods after giving birth between both groups of breastfeeding and non-breastfeeding mothers. Moreover, no difference could be observed in the frequency of medicine use between the fully and partially breastfeeding mothers. This study has also shown that the most frequent used medicinal substances were folic acid, vitamins and/or minerals, analgetics, and antimycotics in the form of vaginal tablets.
Očesna stanja pri bolnikih z okužbo z virusom imunske pomanjkljivosti
Authors: Divjak Darja Dobovšek , Grčar Rok , Valentinčič Nataša Vidović
Published: November 2017

Ocular manifestations may be the frst sign of disseminated systemic HIV infection in HIV-infected individuals. Terefore, it is of the utmost importance to early diagnose ocular conditions that are not responsive to conventional ophthalmic treatment. HIV-related ocular manifestations can aﬀect the anterior (e.g. neoplasia and periocular tissue infections) as well as the posterior segment of the eye (e.g. retinopathy and opportunistic infections of the retina and choroid). Studies confrm that approximately 70 % of all HIV-infected patients suﬀer from at least one ocular manifestation caused by the HIV infection, so regular ophthalmic examinations are necessary in order to early diagnose and treat the disease, which might improve prognosis of the patient and prevent vision loss.In the frst part of the article we present some of the most common HIV-related ocular manifestations, while the second part of the article includes our experience in ophthalmic evaluation, followup and treatment recommendations.
Angiomatozna proliferacija v mrežnici in polipi v žilnici – fenotipa neovaskularizacij pri starostni degeneraciji makule
Authors: Šarenac Tomislav , Groboljšek Žgavc Mateja , Jaki Mekjavič Polona
Published: November 2017

Age-related macular degeneration (AMD) is the leading cause of loss of visual acuity in developed countries. Antagonists of Vascular Endothelial Growth Factor (anti-VEGF) have been successfully used intravitreally in treating the neovascular form of this disease (nAMD) and limiting vision loss. With the latest developments in multimodal imaging we can discern multiple types of neovascularization, some of which have an unusual course, despite treatment with anti-VEGF. Indocianine green angiography (ICGA) and optical coherence tomography (OCT) have been used to distinguish two special forms of nARMD, i.e., retinal angiomatous proliferation (RAP) and polypoidal choroidal vasculopathy (PCV). RAP appears in 10–15 % of newly discovered nARMD, usually in older patients and is also known as type 3 neovascularisation, which starts intraretinally. It responds well to anti-VEGF. However, it requires closer monitoring, since in 75 % of patients it requires repeated treatment. In contrast, PCV evolves in the choroid and typically causes hemorrhagic exudative maculopathy, which is relatively unresponsive to anti-VEGF. It appears in 4–14 % of nAMD, and in somewhat younger patients. It requires a specifc approach to treatment, combining anti-VEGF with laser therapy, and close monitoring.Although PCV and RAP are less common forms of nARMD, we should use and properly interpret FA, ICGA and OCT in order to initiate recommended treatments and follow-up. Herewith we can lessen the adverse impact on the visual acuity and increase the quality of life of our patients.
Development of urinary incontinence in a 7-year old boy after therapy with proton pump inhibitors and complete resolution of his clinicopathologic features of eosinophilic esophagitis after H2-receptor antagonist treatment: A case report
Authors: Orel Rok , Eržen Janez , Dolenc Stražar Zvezdana
Published: November 2017

Background: Several diseases result in profound infltration of esophageal mucosa by eosinophilic granulocites, with gastroesophageal reﬂux disease (GERD), eosinophilic esophagitis (EoE) and proton-pump-inhibitor-responsive esophageal eosinophilia (PPI-REE) being the most prevalent. Proton-pump-inhibitor-responsive esophageal eosinophilia (PPI-REE) is a newly recognized entity that must be diﬀerentiated from eosinophilic esophagitis (EoE).Case presentation: A 7-year old Slovenian male presented with a few-month history of chest pain, regurgitation and heartburn. First endoscopy was performed and revealed pronounced longitudinal furrows, and on hystology examination > 70 eosinophils per high power feld were found through the entire thickness of epithelium and in the submucosis with eosinophilic microabscess formation. Results of 24-hour pH-monitoring (without impedance monitoring) excluded pathologic acid reﬂux. All allergy tests were negative. Te patient started treatment with proton pump inhibitors (PPIs) for three times, twice with pantoprazole before the endoscopy and once with esomeprazole after it to exclude the diagnosis of GERD and PPI-REE. Urinary incontinence reappeared each time just few days after starting treatment and disappeared few days after stopping it. Therefore, urinary incontinence was considered as a plausible adverse eﬀect of therapy with PPIs. As treatment with PPIs was not tolerated, a therapy with H2-receptor antagonists ranitidine was applied for more than 2 months followed by a second endoscopy. Both symptoms and esophageal eosinophilia completely resolved with ranitidine. The resolution of esophageal eosinophilia in PPI-REE has been attributed to proton pump independent antiinﬂammatory eﬀects of PPIs. No such eﬀects have been described in H2-receptor antagonists.Conclusions: Two unique phenomena were observed in the pediatric patient with profound esophageal eosinophilia: urinary incontinence as an adverse eﬀect of therapy with PPIs, and complete resolution of esophageal eosinophilic inﬂammation with typical features of EoE after treatment with H2-receptor antagonists.
Sojini izoflavoni kot pristop prve izbire pri zdravljenju vazomotoričnih težav v menopavzi
Authors: Schmidt Mathias , Arjomand-Wölkart Karin , H. Birkhäuser Martin , R. Genazzani Andrea , M. Gruber Doris , Huber J , Kölbl Heinz , Kreft Samo , Leodolter Sepp , Linsberger Doris , Metka Markus , Simoncini Tommaso , Vrabič-Dežman Lucija
Published: November 2017

The link between higher uptake of isoflavones and a reduced frequency of menopause-related hot flushes were first described in 1992 based on a lower incidence of hot flushes in countries with high dietary soy intake1. Since then, a number of clinical trials with different sources of isoflavones, including soy and red clover, have been performed, and in almost all studies with an appropriate design the outcome was in favour of isoflavone supplementation2. A detailed risk assessment3 revealed that a number of data in humans do not confirm the alleged adverse effect resulting from possible interaction between isoflavones and the hormone-sensitive tissues of the mammary glands, uterus and thyroid. Safety was demonstrated by long-term intake of 150 mg of isoflavones per day, which lasted at least three years. It was also found that a high intake of isoflavones prevented the occurrence of breast cancer4-7. Clinical findings indicate potential benefits of exposure to isoflavones during breast cancer treatment with tamoxifen or anastrozole.
Zunanji obrat ploda na glavico v Porodnišnici Izola
Authors: Lovšin Boštjan , Mrkajić Mladen , Zver-Skomina Janja , Deisinger Dušan
Published: November 2017

Background: Almost all babies in breech presentation at term are delivered by caesarean section. Professional guidelines recommend an attempt of external cephalic version to reduce breech presentations at birth and thus the proportion of caesareans. Our aim was to analyse the clinical and ultrasound factors to predict the outcome of version and check the hypothesis, if the implementation of the external cephalic version helps to reduce the number of caesareans.Methods: The study included all attempts of external cephalic version after 36 weeks of pregnancy at the Department of Obstetrics and Gynaecology in Izola General Hospital from 2002 to 2010.Results: 68/143 (47.6 %) external cephalic versions were successful. the success of intervention was mostly inﬂuenced by a greater amount of amniotic ﬂuid, higher fetal position in the pelvis and transverse or oblique lie of the fetus. With 100 attempts of external cephalic version 32 caesareans were avoided or one cesarean per 3.1 attempts.Conclusions: the study has confirmed that by performing external cephalic version the number of caesareans can be reduced. The proportion of successful versions was comparable to studies in the literature despite the minimal use of uterine muscle relaxants.
Usmerjeno zdravljenje okužbe z bakterijo Helicobacter pylori – ali še obstaja druga pot? Sistematični pregled literature in metaanaliza
Authors: Nemanič Tiva , Mihajlović Mislej Eva , Plut Samo , Štabuc Borut , Jeverica Samo
Published: November 2017

Background. Empiric therapy is a mainstay of Helicobacter pylori eradication strategy. With the epidemics of antimicrobial resistance, it is becoming increasingly difficult to select treatment with at least two active antimicrobial agents, needed for cure. Tailored therapy has not been widely accepted in the past, but has lately resurged as a viable alternative. The aim of the study was to review all available studies comparing tailored and empiric therapy in treatment naïve adult patients.Methods. PubMed database search was conducted for eligible studies from 1996 to 2016 in English language. All relevant studies were included. Studies that compared standard triple and tailored therapy were included in the meta-analysis. Cumulative relative risk (RR) for eradication success was calculated.Results. Eight studies integrating 2521 participants were evaluated and 7 integrating 1853 patients were included in the meta-analysis. Different tailored approaches were recognized. However, all studies favoured tailored over empiric strategy. Cumulative RR was 1.27 (1.18-1.27) for intention-to-treat (ITT) analysis and 1.28 (1.18-1.38) for per-protocol (PP) analysis.Conclusion. Based on available evidence, tailored therapy is a better alternative to standard triple therapy for eradication of H. pylori. Evidence exist that such approach is also cost effective.
Kašelj pri otrocih
Authors: Praprotnik Marina , Županič Melanija , Lozej Tina , Krivec Uroš , Za pediatrično pulmologijo Delovna skupina
Published: November 2017

Cough is a common problem in children. Acute cough lasts less than 3 weeks, subacute 3–8 weeks and chronic cough more than 8 weeks.Acute cough is usually caused by common viral upper respiratory tract infection. However, the child should be thoroughly evaluated to rule out a serious underlying condition or disease responsible for the cough.The commonest cause of subacute cough is a viral infection (postinfectious cough) and it usually resolves spontaneously. If the child is otherwise well and the cough is dry and there are no specific alerts for a serious disease and the cough is resolving, a period of observation is all that is recommended. If there are any specific pointers in history and examination identified for an inhaled foreign body, chronic lung disease, or in a case of progressive cough, immediate investigations are needed.Most chronic coughs in childhood are due to viral infections, but may signify a serious underlying disease too. Chronic cough is subdivided into specific cough (i.e., cough associated with other symptoms and signs suggestive of an associated or underlying problem) and nonspecific cough (i.e., dry cough in the absence of an identifiable respiratory disease of known etiology).To prevent unnecessary investigations and ineﬀective treatment, and at the same time not to overlook a severe underlying disease, cough guidelines have been designed which are based on evidencebased medicine.
Sekundarni psevdohipoaldosteronizem pri novorojenčku z akutnim vnetjem sečil – Prikaz primera
Authors: Stepišnik Alenka , Cetin-Lovšin Irena , Posega-Devetak Sonja
Published: November 2017

Hiponatremia and hyperkalemia in a newborn can be a life threatening disorder caused by diﬀerent diseases, including congenital adrenal hyperplasia, or less frequently by a genetical or acquired tubular cell resistance to aldosteron, called pseudohypoaldosteronism. Secondary pseudohypoaldosteronism is a rare, reversible electrolyte disorder caused by aldosterone resistance in infants with congenital urinary tract malformations and/or urinary tract infection.We present a 4-week-old boy with severe hyponatremia, hyperkalemia and elevated aldosterone levels during an episode of pyelonephritis. The disorder improved completely with antibiotic treatment, rehydration and electrolyte correction. Further investigations showed no structural urinary tract anomalies. According to the literature, we concluded that electrolyte disturbances were caused by aldosterone resistance of the inﬂamed tubular cells and subsequent defective transepithelial sodium transport.
Congenital heart disease detection in Slovenia: Improvement potential of neonatal pulse oximetry screening
Authors: Narancsik Zoltan , Mramor Minca , Vesel Samo
Published: November 2017

Introduction: Patients with major or critical congenital heart disease (CHD) require surgical treatment or interventional cardiac catheterization during the first year or 28 days of life, respectively. Currently, the detection of CHD in Slovenia relies on the prenatal ultrasound screening and physical examination of the newborn.Aims: 1) To determine the incidence of major/critical CHD in Slovenia; 2) to determine the proportion of infants with late detection of major/critical CHD based on the existing clinical practice; and 3) to estimate the improvement in CHD detection with a nation-wide neonatal pulse oximetry screening programme.Methods: We reviewed the documentation of all patients with major/critical CHD born in Slovenia in years 2007–2012. We determined whether the heart condition was detected: 1) on time – prenatally or prior to discharge from maternity ward; or 2) late – after discharge or at autopsy.Results: Among 128,839 live-born babies, 293 were diagnosed with a major CHD (2.27/1000 live births, 95 % confidence interval (CI): 2.0–2.5/1000) and of those 150 with a critical CHD (1.16/1000 live births, 95 % CI: 1.0–1.4/1000). Late detection occurred in 17.7 % of patients with major and 10.9 % patients with critical CHD. Out of 15 late-detected patients with critical CHD, 14 had an obstructive left heart lesion. In 2 patients CHD was diagnosed after death.Conclusions: Detection of CHD in Slovenia is satisfactory. However, in the observed period, 10.9 % of newborns with a critical CHD were discharged undiagnosed. A nation-wide pulse oximetry screening programme could improve pre-discharge CHD detection.
Streptococcus salivarius kot povzročitelj iatrogenega meningitisa – predstavitev primera
Authors: Praper Kristina , Tišler Uršula , Jereb Matjaž
Published: November 2017

We present a case of a 28-year-old patient who underwent spinal anaesthesia for caesarean section, and developed meningitis, Streptococcus salivarius was isolated in the cerebrospinal ﬂuid. The Viridans streptococci are a part of a normal human mouth ﬂora, therefore the patient most likely developed iatrogenic meningitis due to droplet transmission of bacteria intrathecally. We discuss etiology, pathogenesis, clinical presentation, diagnostic tools, treatment and prognosis of meningitis afer intrathecal procedures and we emphasize the importance of strict aseptic technique while performing neuraxial procedures. Iatrogenic meningitis should be considered as a possible diﬀerential diagnosis in patients who present with symptoms and signs of meningitis after neuraxial blockade.
Laparoskopska resekcija jeter zaradi zasevkov raka debelega črevesa in danke – rezultati zdravljenja
Authors: Ivanecz Arpad , Pivec Vid , Plahuta Irena , Krebs Bojan , Jagrič Tomaž , Potrč Stojan
Published: November 2017

Background: In many referral centers, laparoscopic liver resection (LLR) is a well-established method for the management of colorectal liver metastases (CLM). The aim of this study is to review a single institution experience.Methods: Between April 2008 and September 2016, 58 patients underwent LLR for various benign and malignant liver tumors. The analysis included 12 patients operated on for CLM. The primary outcomes of this prospective non-randomized study included operative procedure and operating time (minutes), estimated blood loss (mL), conversion rate, R0 resections, resection margins (mm), length of hospital stay (days), post-operative morbidity, and mortality. The secondary outcome of the study was survival analysis.Results: Eight patients (67 %) had atypical LLR. The average operating time was 130 minutes (range 60–210 minutes). The mean estimated blood loss was 140 mL (range < 50–600 mL). In one patient LLR was converted to open procedure (conversion rate 8 %). Seven patients (58 %) had one liver metastasis. The mean metastasis size was 3.6 cm (range 1–9 cm). R0 resection was achieved in all cases. The mean resection margin was 6.8 mm (range 2–15 mm). Te mean length of hospital stay was 6 days (range 3–12 days). Morbidity and mortality rates were 0 %. The median follow-up for surviving patients was 13 months. Nine patients are alive with no evidence of disease, two patients are alive with disease and one patient died of disease.Conclusion: LLR is a feasible and safe method for the treatment of CLM and there is no compromise of oncological surgical principles.
Vloga lečnih epitelnih celic pri razvoju zamotnitve zadnje lečne ovojnice in pri obnovi leče po operaciji prirojene sive mrene
Authors: Andjelic Sofija
Published: November 2017

Posterior capsule opacifcation–PCO is the most common complication after cataract surgery. Proliferation and migration of lens epithelial cells that remain in the capsular bag following cataract surgery can lead to the development of PCO, which is the main cause of deterioration of visual function. PCO shows the classic features of fbrosis, including hyperproliferation, migration, deposition of matrix and its shrinkage and transdiﬀerentiation into myofbroblast. Astonishingly, the results of recent research show the importance of lens epithelium for lens regeneration following congenital cataract surgery. New minimally invasive cataract surgery removes only 1–1.5 mm of lens epithelium more laterally, so the major part of the epithelium remains in the capsular bag. Conceptually, the new method diﬀers from the current practice, since it preserves the endogenous epithelial cells of the lens and achieves functional lens regeneration in rabbits and monkeys as well as in human infants with congenital cataracts. Pluripotency of lens epithelial cells and their stem cell nature are crucial for lens regeneration.Ex vivo cultures of the lens capsule explants can be used for testing the pharmacological agents for stimulating and inhibiting the growth of lens epithelial cells. Functionality of the cells and responses to pharmacological agents can be studied by analyzing the intra- and extra-cellular calcium (Ca2+) signaling. Stimulating the growth of lens epithelial cells is important in lens regeneration while inhibiting the growth of lens epithelial cells is important in preventing the development of PCO. In the article I described the methods for the analysis of lens epithelial cells after cataract surgeries, which are carried out in the laboratory of the Eye Hospital, University Medical Centre Ljubljana.