Acta Medica Croatica最新文献

{"title":"[ADRENOCORTICAL CARCINOMA].","authors":"K Kranjčević","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Adrenocortical carcinoma is a rare entity. However, it is the most common type of cancerous adrenal gland tumor with\u0000poor prognosis. Approximately 4 to 12 per 1 million people develop this type of tumor, which begins in the adrenal cortex.\u0000Adrenocortical carcinoma can occur at any age. Women tend to be diagnosed slightly more often than men. In most cases,\u0000the cause of cancerous adrenal gland tumor remains unknown. However, people with certain hereditary conditions have a\u0000higher risk. Adrenocortical carcinoma can be a functional or nonfunctional tumor. If the tumor is functional, it may produce\u0000hormones causing symptoms such as high blood pressure, low potassium level, heart palpitations, nervousness, feelings\u0000of anxiety or panic attacks, excessive perspiration, diabetes, Cushing syndrome, unexplained weight gain or weight loss,\u0000weakness, abdominal stretch marks, excessive hair growth, changes in genitalia, change in libido, etc. If the tumor is\u0000nonfunctional, symptoms occur because the tumor has grown so large that it exerts pressure on the nearby organs,\u0000causing abdominal pain or a feeling of fullness. To diagnose adrenocortical carcinoma, in addition to thorough physical\u0000examination, the following tests are used: blood and urine tests to help determine whether the tumor is functional or\u0000nonfunctional, and imaging tests (computed tomography scan or magnetic resonance imaging). The treatment depends on\u0000cancer stage. Two major staging systems are used: the American Joint Committee on Cancer (AJCC) TNM staging system\u0000and the ENSAT (European Network for the Study of Adrenal Tumors) staging system. Both are based on the same TNM\u0000categories. The main types of treatment for adrenal cancer are surgery (the main treatment), chemotherapy and targeted\u0000therapy. Radiation therapy is not used often as the main initial treatment for adrenal cancer because the cancer cells are not\u0000easy to kill with x-rays. Radiation may be used as adjuvant therapy. By definition, adrenal incidentaloma is an asymptomatic\u0000adrenal mass detected on imaging not performed for suspected adrenal disease. In most cases, adrenal incidentalomas\u0000are nonfunctional adrenocortical adenomas, but may also represent conditions requiring therapeutic intervention (e.g.,\u0000adrenocortical carcinoma, pheochromocytoma, hormone-producing adenoma, or metastasis).</p>","PeriodicalId":35756,"journal":{"name":"Acta Medica Croatica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35507731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[RESISTANT ARTERIAL HYPERTENSION – APPROACH TO PATIENT IN FAMILY\u0000MEDICINE].","authors":"I Diminić-Lisica,&nbsp;L Bukmir,&nbsp;I Lisica","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Increasing the proportion of patients with controlled hypertension implies understanding and systematic approach to\u0000patients with resistant hypertension. In the past decades, an increase in the prevalence of resistant arterial hypertension\u0000(RAH) has been observed and the incidence of this problem is becoming greater in the practice of family physicians.\u0000Patients with RAH have a higher prevalence of target organ damage as compared with patients having achieved target\u0000blood pressure values, and their risk of an adverse cardiovascular event is tripled. RAH is defined as hypertension in which\u0000there is no satisfactory control of blood pressure despite compliance to lifestyle changes and taking at least three drugs\u0000in full doses, one of which has to be a diuretic. The most important risk factors for resistance to treatment are older age,\u0000obesity, smoking, excessive intake of salt and alcohol, the presence of left ventricular hypertrophy, chronic renal failure,\u0000diabetes, inadequate baroreflex pathway, chronic stress and associated mental states, use of some drugs, and all forms of\u0000secondary hypertension. One-fifth of patients with RAH have primary aldosteronism. Obstructive sleep apnea is a common\u0000cause of RAH, and literature reports point to its increasing frequency. Optimal treatment involves a combination of three\u0000drugs, one of which is a diuretic. Use of mineralocorticoid antagonist as the fourth drug has shown significant efficacy even\u0000in patients who do not have elevated levels of aldosterone. New invasive methods of treatment include renal denervation\u0000and permanent electrical stimulation of the carotid sinus. The aim of this paper is to emphasize the importance of RAH\u0000as a cardiovascular risk factor, along with early detection and treatment at the family medicine level and timely referral to\u0000additional procedures to treat the specific forms of RAH.</p>","PeriodicalId":35756,"journal":{"name":"Acta Medica Croatica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35558687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[ANEMIA IN CHRONIC KIDNEY DISEASE].","authors":"L Bukmir,&nbsp;M Fišić,&nbsp;I Diminić-Lisica,&nbsp;A Ljubotina","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Renal anemia develops secondary to chronic kidney disease (CKD) and its incidence increases with the progression of CKD.\u0000The aim is to inform family physicians about the latest developments and ways of approaching the issue, in accordance\u0000with national guidelines. The PubMed and Cochrane systematic reviews databases were searched for the 1996-2015 period\u0000using the following key words: anemia, chronic renal failure, erythropoietin, and primary health care. In addition, all relevant\u0000articles and textbooks available were manually searched to suggest the following conclusions. The use of erythropoiesis-stimulating\u0000agents (ESA) slows down the progression of CKD, reduces the need for blood transfusions and improves the\u0000patient quality of life. Target hemoglobin (Hb) concentration to be permanently maintained is 110-120 g/L. Higher Hb levels\u0000are associated with higher mortality and major cardiovascular events in dialysis patients. Target hemoglobin level should\u0000be strictly individualized depending on CKD stage (both non-dialyzed and dialyzed population), age, other risks, initial and\u0000maintenance treatment. Early recognition and appropriate correction of anemia using ESA is of utmost importance in CKD\u0000patients. Systematic primary and secondary prevention measures along with education and professional implementation\u0000of national guidelines in daily work of family practitioners can improve medical care of patients with CKD.</p>","PeriodicalId":35756,"journal":{"name":"Acta Medica Croatica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35558685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[KIDNEY DISEASE IN DIABETIC PATIENTS – THE ROLE OF FAMILY MEDICINE\u0000PHYSICIAN].","authors":"V Bralić Lang,&nbsp;Maja Baretić,&nbsp;E Pavić","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The alarming rates of diabetes mellitus incidence and progression continue despite deployment of all current treatments.\u0000Kidney disease can be a particularly devastating complication, as it is associated with significant reductions in both length\u0000and quality of life. A variety of forms of kidney disease can be seen in people with diabetes, including diabetic nephropathy,\u0000ischemic damage related to vascular disease and hypertension, as well as other renal diseases that are unrelated to\u0000diabetes. Following an extensive PubMed search, this review provides a brief view on the screening for chronic kidney\u0000disease (CKD) in people with diabetes, how to treat them to slow down the progression of CKD and when to refer them\u0000to specialist care. This review also emphasizes the basic challenge in treating diabetic patients, which is to shift the main\u0000criterion from the disease-oriented to person-centered approach in the context of treating the patient as a whole.</p>","PeriodicalId":35756,"journal":{"name":"Acta Medica Croatica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35559233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[COMPLICATED URINARY TRACT INFECTIONS IN THE ELDERLY].","authors":"I Ćosić,&nbsp;V Ćosić","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Urinary tract infections (UTI) are the most common bacterial infections involving lower (cystitis, prostatitis) or upper\u0000(pyelonephritis, renal abscess, perinephric abscess) urinary tract. Differentiation of complicated and uncomplicated UTI\u0000is usually based on the presence of structural or functional urinary tract abnormalities, which can increase the risk of\u0000treatment failure and development of serious complications. Factors that increase the risk are foreign bodies, stones,\u0000obstruction, neurogenic bladder, kidney transplantation, immunosuppression, and pregnancy. Complicated UTI includes a\u0000spectrum of conditions that increase the risk of treatment failure, as well as of serious complications such as bacteremia\u0000and sepsis, perinephric abscess, renal impairment and emphysematous pyelonephritis. To avoid the potentially devastating\u0000outcomes, appropriate diagnostic procedures, antibiotic and surgical treatment, and appropriate follow-up are required.\u0000The incidence of complicated UTI will grow in the future due to general aging of the population, increasing incidence of\u0000diabetes, and ever growing number of immunocompromised and immunosuppressed patients. It is of key importance to\u0000recognize complicated UTI on time, and treat it wisely and aggressively to reduce duration of the disease and the risk of\u0000antibiotic resistance.</p>","PeriodicalId":35756,"journal":{"name":"Acta Medica Croatica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35562511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[DIET CHARACTERISTICS IN PATIENTS WITH CHRONIC KIDNEY DISEASE].","authors":"N Bašić-Marković,&nbsp;I Šutić,&nbsp;B Popović,&nbsp;R Marković,&nbsp;J Vučak","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Because of the increasing number of patients, chronic kidney disease (CKD) has become a significant public health\u0000problem. As kidney function decreases, it is necessary to introduce certain dietary modifications. The aim was to investigate\u0000what is the appropriate approach to diet of CKD patients, which could contribute to slowing down progression of the\u0000disease. Dietary recommendations are individual for each patient, but also vary in the same patient depending on the\u0000stage of disease progression because special attention must be paid to appropriate intake of macronutrients (protein,\u0000carbohydrates and fats), micronutrients (sodium, potassium, calcium, phosphorus, zinc, selenium, various vitamins), and\u0000water. In newly diagnosed patients, it is necessary to assess their nutritional status and energy requirements. It has been\u0000shown that protein-energy malnutrition, muscle loss and cachexia are strong predictors of mortality in CKD. Comparing\u0000different dietary approaches in everyday life of patients suffering from CKD, it was found that the most effective diet is\u0000Mediterranean food style. Studies confirm that Mediterranean diet has a preventive effect on renal function and reduces\u0000progression of the disease. Preventive measures, correct identification and early intervention can increase survival of\u0000patients and improve their quality of life. Mediterranean diet tailored to individual stages of CKD has been confirmed as the\u0000best choice in CKD patients.</p>","PeriodicalId":35756,"journal":{"name":"Acta Medica Croatica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35557245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[RENAL CYSTS IN ADULTS].","authors":"Đ Lovrinić,&nbsp;B Lodeta,&nbsp;T Zavidić","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Cystic kidney diseases is a heterogeneous group of developmental, hereditary and acquired disorders that result in the\u0000occurrence of one or more cysts on one or both kidneys, and are relatively common. Cystic kidneys can also occur as one\u0000of various syndromes of malformations. Kidney cysts can have several classifications, depending on the properties taken\u0000in consideration. Some patients remain symptom free for life, whereas others develop serious clinical symptoms that may\u0000sometimes be life threatening. It is important to keep in mind the existing classifications, differentiate their succession,\u0000clinical course, treatment and prognosis, as well as potential complications. The objective of this paper is to present\u0000the most prevalent types of cysts with accompanying clinical symptoms and point out their importance, prevalence and\u0000possible association with other serious medical conditions.</p>","PeriodicalId":35756,"journal":{"name":"Acta Medica Croatica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35558689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[NEPHROTOXIC DRUGS].","authors":"B Popović,&nbsp;I Šutić,&nbsp;N Bašić Marković","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Renal tissue is sensitive to the effect of potentially nephrotoxic drugs and other substances that are available over-the-counter\u0000or can be purchased at healthy food stores or elsewhere, and harmful substances from the environment. The\u0000harmful effects of these substances lead to the development of recognizable clinical syndromes, including acute or chronic\u0000renal failure, tubulopathy, and proteinuria. Risk factors that influence the development of kidney disease induced by drugs\u0000are divided into those related to patient characteristics, drug characteristics, and renal function. Drugs that commonly\u0000exhibit nephrotoxic effects are analgesics, antimicrobials, chemotherapeutics, contrast agents, immunosuppressants,\u0000herbal preparations and substances containing heavy metals. Family physician must carefully observe their patients,\u0000nurturing individual approach to drug selection and determining the dose. Renal function can quickly return to normal if the\u0000damage is recognized on time. Recent research yields insights into the identification of new biomarkers that will contribute\u0000to early detection of drug induced kidney damage.</p>","PeriodicalId":35756,"journal":{"name":"Acta Medica Croatica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35558691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[COCHRANE SYSTEMATIC REVIEWS ON PROSTATE CANCER].","authors":"D Vrdoljak","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Prostate cancer is a common malignant tumor of the elderly, which accounts for a significant proportion of total morbidity\u0000but very low of mortality. In Croatia, it is the second most common cancer in men. Currently, there are many doubts\u0000concerning screening, early detection and treatment of prostate cancer. Therefore, this article brings results of Cochrane\u0000systematic reviews (SRs) on the topic of prostate cancer published in the last eight years. In June 2016, Cochrane database\u0000of systematic reviews was searched using the following keywords: Systematic Reviews, and Prostate Cancer (Malignancy,\u0000Neoplasm). Inclusion criterion was publication date of the Cochrane SR or its update in the last eight years. The abstracts\u0000were initially screened and those that matched the topic were included in further analysis. Then full texts of all SRs involved\u0000were obtained. SRs were classified into four topics: prevention, screening, treatment and psychosocial aspects. Our search\u0000retrieved a total of 19 Cochrane SRs on the topic of prostate cancer. Excluded were four articles that did not match the\u0000specific topic, and the remaining 15 full texts were obtained. One of these was on screening, two on prevention, the\u0000majority, i.e. eleven were on treatment, and one on the psychosocial aspects related to prostate cancer. Based on the\u0000results of the Cochrane SRs on prostate cancer, instead of mass/population screening, the individualized/opportunistic\u0000screening approach should be applied in men aged 55-69, always providing full information to the patient and taking into\u0000account the potential benefits and harms of this procedure.</p>","PeriodicalId":35756,"journal":{"name":"Acta Medica Croatica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35562512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[GLYCEMIC CONTROL IN DIABETES MELLITUS PATIENTS WITH CHRONIC KIDNEY\u0000DISEASE – HOW TO CHOOSE HYPOGLYCEMIC AGENT]?","authors":"M Baretić,&nbsp;V Bralić Lang","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The management of hyperglycemia in patients with chronic kidney disease (CKD) is complex, and the goals and methods\u0000regarding glycemic control are not clearly defined. Although aggressive glycemic control seems to be advantageous in\u0000early diabetic nephropathy, outcome data supporting tight glycemic control in patients with advanced CKD are lacking.\u0000Challenges in the management of such patients include monitoring difficulties and the complexity of available treatments.\u0000In this article, we review the current treatment options for patients with diabetes and CKD discussing all hypoglycemic\u0000agents that currently are available, as well as insulin, along with their indications and contraindications. The aim is to\u0000provide useful information to family physicians when deciding on individualized glycemic goals and appropriate therapy\u0000for patients with early or end stages of CKD.</p>","PeriodicalId":35756,"journal":{"name":"Acta Medica Croatica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35557239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}