Biomedical subjects

Mate Skegro

Publications and source records attributed to Mate Skegro.

6 recordsLinked to original sources

PubMed2006

Improving comprehension of informed consent.

OBJECTIVE: To explore the way the doctor-patient communication process may be improved by adopting the patients' conversational style in the development of written materials for surgical patients. METHODS: Written information prepared by doctors, specialists in abdominal surgery, was tested for comprehension on patients undergoing cholecystectomy, using the standard Cloze test procedure. At the same time, the patients were asked to describe in their own words all they knew about their illness and the treatment. The collected 150 patient narratives were analyzed, and a typical narrative for each educational level was selected based on average SMOG score, word count and sentence length. The patient-worded information was then tested for comprehension on new patients, selected from primary health care, using the same Cloze procedure as with doctor-developed information. Patient profile of best lay communicators was defined using also sociodemographic characteristics, and reported information seeking and decision making preferences. RESULTS: Only 50% of patients completed Cloze test, of which over 40% showed poor comprehension. Analysis of transcribed narratives collected from 150 patients showed increasing complexity of style by educational level (average SMOG score 7, 8, and 9; sentence length 11, 13, and 15 words; for low, medium, and high educational level, respectively). Cloze tests based on typical narratives, and tested on primary care patients, indicated to the style best understood by all. Dominant characteristics of patients producing a narrative of similar style to the best-understood narrative were observed: medium educational level, women over 60, urban workers, interviewed after surgery, informed by specialist at ultrasound, knowledge about illness from 1 to 10 years, learned most about illness from lay people, those who wanted more information in both oral and written form, and preferred active role in decision making. CONCLUSION: Analysis of patient profiles with typical narratives that were best understood by other patients shows where to look for lay experts in doctor-patient communication. PRACTICE IMPLICATIONS: Obtained findings indicate to the importance of patient participation in developing informed consent information, and to the possible method for improving comprehension of educational patient materials in general.

Adolescent↗

PubMed2006

Cholelithiasis and thrombosis of the central retinal vein in a renal transplant recipient treated with cyclosporin.

The use of cyclosporin has been associated with the development of cholelithiasis in transplant recipients. Cholelithiasis in turn enhances the effects of cyclosporin on increased platelet aggregation. In this report, a patient who had undergone a renal transplantation as a result of malignant hypertension, and who was on immunosuppressive therapy consisting of cyclosporin, prednisone and azathioprine, developed thrombosis of the central retinal vein 5 years following the transplantation. Seven years after the transplantation, cholelithiasis, cholecystitis, cholangitis and subsequently secondary chronic biliary sclerosis were detected. Latero-lateral anastomosis between the common bile duct and duodenum was performed during explorative laparotomy and ursodeoxycholic acid treatment was introduced. The possible inter-relationship of the cholestatis, central retinal vein thrombosis and immunosuppression are discussed.

Adult↗

PubMedDate not supplied

[Laparoscopic approach to incisional hernia--Carbajo procedure].

Incisional hernia is a common entity and occurs often in patients with previous operations in the abdominal cavity and the abdominal wall. In such patients, surgical therapy is challenging, since the recurrence rate varies between 14 and 50%. New technologies enabled the production of a new biocompatible non-adhesive mesh. Such a mesh can be placed inside the abdominal cavity in direct contact with the abdominal organs. A new laparoscopic approach, with original surgical details, was developed by Carbajo. In this article, we are presenting the results of first Carbajo procedure performed at our department in November 2003.

Abdominal Wall↗

PubMedDate not supplied

[Laparoscopic colorectal surgery].

Laparoscopy is not a standard approach for colorectal diseases yet. This is due to the technically demanding procedure, the necessary equipment and open questions on cancer surgery. In this paper, short-term results in a small group of patients together with a review of the recent publications are presented. Six patients were operated between April 2002 and October 2003, without intraoperative complications or conversions. The average operation time was 120 minutes, and the average hospital stay was seven days. Patients with colorectal carcinoma were operated with curative intent. Recent publications are presenting new information on laparoscopy and colorectal cancer. For an adequate laparoscopic colorectal resection, experience in laparoscopy together with proper education is mandatory.

Aged↗

PubMedDate not supplied

[Imatinib in gastrointestinal stromal tumor treatment--results from University Hospital Centre Zagreb].

Gastrointestinal stromal tumours (GIST) may be defined as intraabdominal mesenchymal tumours that express KIT protein or have an activating mutation in class III receptor tyrosine kinase gene (KIT or PDGFRalpha). Most GISTs respond to imatinib mesylate, which selectively inhibits both KIT and PDGFRalpha, and is now considered standard systemic therapy for advanced GIST. We assessed the antitumour response of patients treated with imatinib mesylate who had advanced and/or metastatic (GIST). In the Department of Medical Oncology fourteen (14) patients with advanced GIST were treated in the period from year 2002 to 2004. Imatinib mesylate was applied at the dose of 400 mg daily. Only two patients required dose enlargement up to 800 mg. All tumours had positive immunohystochemical expression of KIT. Median age of patients was 56 years. 12 male patients and 2 female patient was treated. Considering primary site of tumour we had 6 small intestine, 4 mesenterium and 4 gastric tumours. Mean duration of the treatment was 14 months (5 to 30 months). Six patients had partial remission, six had stable disease and two progression. Complete remission has not been achieved in any patient. Side-effects were mild and no patient required dose reduction or treatment discontinuation. Our results show the effectivness of targeted antitumour therapy with imatinib mesylate in advanced and/or metastatic GIST, and correspond to those in literature.

Adult↗

PubMedDate not supplied

[Primary pigmented nodular adrenocortical disease as cause of Cushing's syndrome associated with Carney complex].

We report a 11-year-old girl and two 14-year-old boys with Cushing's syndrome due to primary pigmented nodular adrenocortical disease (PPNAD). In these patients, hypercortisolism is a consequence of autonomous cortisol secretion from adrenal glands and is ACTH-independent. Besides PPNAD, the girl had lentigines, spotty pigmentation on her bucal mucosa and lips and she also had schwannoma. One of the reported boys had prolactinoma. Considering this, those two patients fulfill the criteria for Carney complex which is a type of multiple endocrine neoplasia syndromes inherited in an autosomal dominant trait. The other boy had PPNAD but no other obvious signs of Carney complex were noticed. Family study didn't reveal any clinical or laboratory signs of Carney complex in our patients' first relatives. All of our patients underwent bilateral adrenalectomy (in one of the boys laparoscopic surgery was performed). Glucocorticoid and mineralocorticoid substitution has been started. Adrenal glands were macroscopically normal but pathohistological analysis confirmed the diagnosis of PPNAD.

Adolescent↗