2013-05-20T07:55:58Z http://hrcak.srce.hr/oai/

oai:hrcak.srce.hr:10203 2008-06-03 journal:31

Nekoć koštano-zglobna tuberkuloza i prva dva ortopeda u Dalmaciji Bone and joint tuberculosis in the past and the first two orthopedists in Dalmatia Marinović, Ivo tuberkuloza kostiju i zglobova; liječenje; specijalisti bone and joint tuberculosis, treatment, specialists Koštano-zglobna tuberkuloza zbog siromaštva stanovništva, osobito tijekom II. svj. rata, a i kasnije, uzimala je maha. Najviše su bila ugrožena djeca i mlađe stanovništvo pa je ona bila jedan od većih društvenih problema. Nije bilo odgovarajućih lijekova, nije bilo mjesta u bolnicama, a ni odgovarajućih specijalista. Godine 1940. bio je u bolnici u Splitu osnovan prvi ortopedski odjel u cijeloj Dalmaciji s jednim specijalistom. Bio je to dr.Dušan Vlašić. Godine 1946. bila je osnovana specijalna bolnica za koštano-zglobnu tuberkulozu u Biogradu n/m s 80 kreveta. Ravnatelj i prvi i jedini liječnik specijalist u toj bolnici bio je dr. Niko Carević. Njih dvojica bili su prvi i jedini specijalisti ortopedi u cijeloj Dalmaciji. Bone and joint tuberculosis spread particulary during the Second World War, and also later, due to the poverty of the population. As children and the younger population were particulary endangered, it presented one of the major social problems. There were no adequate drugs, no places in hospitals, and no adequate specialists. The first Orthopedic Department in the whole of Dalmatia was founded at the hospital in Split in the year 1940, with one specialist, dr. Dušan Vlašić. A special hospital for bone and joint tuberculosis was founded in Biograd n/m in the year 1946. The head, and at the same time the first and only specialists, was dr. Niko Carević, dr. Vlašić and dr. Carević were the first and only specialists orthopedists in the whole of Dalmatia. General hospital Zadar 2007-01-20 text pdf http://hrcak.srce.hr/10203 http://hrcak.srce.hr/file/15715 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.36 No.1-2; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:10430 2008-06-03 journal:31

Epidemiološke karakteristike intravenskih ovisnika Zadarske županije Epidemiologic characteristics with injection drug users in Zadar County Medić, Alan Dželalija, Boris Ovisnost, obrazovanje, obitelj, materijalni status Addiction, education, family, material status U našem istraživanju analizirali smo, primjenom upitnika iz Pompidou obrasca, deskriptivna epidemiološka obilježja zabilježena u medicinskoj dokumentaciji u 327 intravenskih ovisnika u Centru za prevenciju i izvanbolničko liječenje bolesti ovisnosti u Zadru. Od ukupnog broja ispitanika većina je muškog spola (273; 83,4%), a omjer među spolovima je 5 muškaraca:1 žena. Ukupno najveći broj ispitanika nalazi se u dobnoj skupini od 21 do 25 godina (99; 30,3%), većina njih je (276; 84,4%) stekla cjelovito ili djelomično srednjoškolsko obrazovanje, živi s primarnom obitelji (200; 61,2%), prvo su kažnjivo djelo počinili nakon što su počeli uzimati teške droge (161; 49,2%), a manjina njih je cijepljena protiv B hepatitisa (49; 15%). Za problem ovisnosti najčešće prvi saznaju članovi obitelji (51,4%), većina roditelja ovisnika je u braku (209; 63,9%) i sazna da su njihova djeca ovisnici nakon 2-4 i više godina (53,8%). Većina roditelja ovisnika ima prosječan materijalni status (150; 55%) i srednjoškolsko obrazovanje (201; 61,5%). Model ranog otkrivanja bolesti ovisnosti i smanjenja broja teških ovisnika označava obitelj kao kjučno mjesto gdje se provode sve mjere primarne i sekundarne prevencije bolesti ovisnosti, uz povezanost i suradnju državnih ustanova u kojima se provode tercijarne mjere s ciljem rehabilitacije i resocijalizacije ovisnika. In our research we have used the Pompidou from to analyze the descriptive epidemiologic features reported in the medical documents of 327 injection drug users in the Center for Prevention and Out-Patient Treatment of Addicts in Zadar. Most of the examinees were of male gender (273; 83,4%) and the gender ratio was 5 men: 1 woman. The greatest number oexaminees belongs to the 21-25 age group (99; 30,3%), most of them have partly or entirely (276; 84,4%) finished secondary school, living with their primary family (200; 61,2%), have vaccinated against hepatitis B (49; 15%). Members of the family are most often the first to find out of the addiction (51,4%) most of the addicts parents are married (209; 63,9%) and find out of their children's addiction after 2-4 years and more (53,8%). Most of the addicts parents are of average material status (150; 55%), and have a secondary school education (201; 61,5%). The early addiction discovery model and the number of addicts reduction indicates the family as the key place to enforce all primary and secondary measures of drug addiction prevention, connected with the cooperation with goverment institutions where tertiary measures take place in the aim of addicts rehabilitation and resocialization. General hospital Zadar 2007-01-20 text pdf http://hrcak.srce.hr/10430 http://hrcak.srce.hr/file/16013 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.36 No.1-2; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:10439 2008-06-03 journal:31

Prehrana u domovima za starije osobe u Splitu Nutrition in old people's homes in Split Ćurin, Katja Marušić, Jadranka Čulin, Sanja Osobe starije dobi, domovi umirovljenika, prehrana, prehrambeni standardi, evaluacija prehrane. the elderly, old people's homes, nutrition, nutritional standards, nutrition evaluation Prehrambena i energetska vrijednost obroka trebaju biti u skladu sa specifičnim potrebama u ljudi starije životne dobi. Izbor namirnica i prehrambeno-energetsku vrijednost dnevnih obroka treba uskladiti s fiziološkim promjenama na kardiovaskularnom, lokomotornom, gastrointestinalnom, endokrinom i ostalim sustavima u starijih osoba. U radu se ispitivala kvaliteta prehrane u domovima za starije osobe u Splitu u odnosu na preporučene vrijednosti radi predlaganja mjera za unapređenje. U razdoblju od 1999. do 2004. godine u Nastavnom zavodu za javno zdravstvo u Splitu ispitana je prehrambena i energetska vrijednost 108 dnevnih obroka uzetih 6 puta godišnje metodom slučajnog izbora u tri doma za starije osobe u Splitu. Analizirane vrijednosti uspoređene su sa zadanim normativima. Ispitivana je i učestalost korištenja namirnica iz osnovnih skupina. Zadovoljenje bjelančevina u odnosu na normativ kreće se u rasponu od 72,5% do 116,6% masti od 66,7 do 159,7%, ugljikohidrata od 86,4% do 107,9% energetske vrijednosti od 83,0% do 119,4% u istraživanom razdoblju. Vrijednosti su dosta neujednačene i variraju po domovima i godinama. Udio prehrambenih tvari u ukupnoj energetskoj vrijednosti obroka značajno ne odstupa od zadanih preporuka. Jelovnici su jednolični, a prema anketi nedovoljno su zastupljene sljedeće namirnice: riba, riblji proizvodi, mlijeko i mliječni proizvodi, mahunarke te sezonsko voće i povrće. Često se koriste masna jela. Jelovnik bi trebalo raznoliko sastaviti te češće jesti ribu i riblje proizvode, sezonsko svježe voće i povrće, nemasne mliječne proizvode, pileće, teleće i pureće meso bez masnoća te proizvode od integralnih žitarica. Izmjene u prehrani pozitivno bi utjecale na tijek i komplikacije kroničnih bolesti u starijih osoba. Food selection and the nutritional-energetic value of daily meals should be adjusted to the physiological changes in cardiovascular, musculosceletal, gastrointestinal, endocrine and other systems of the elderly. The aim of this paper was to examine the nutrition quality of old people's homes in Split according to recommended values for proposing measures of improvement. At Split Public Health Teaching Institute, food and energetic values of 108 daily meals taken on a monthly basis (6 times a year) from three old people's homes in Split were examined from 1999 to 2004 using the random selection method. The analyzed values were compared with prescribed standards. The frequency of staple food usage was also examined. The correspondence of proteins in relation to standard ranged from 72,5% to 116,6%, fats from 66,7% to 159,7% and carbohydrates from 86,4% to 107,9%, with energetic value from 83,0 % to 119,4% for the examined period. The values were quite unequal and varied according to ages and homes. The nutritional matter portion in the total energetic value did not deviate significantly from the recommended values. The menues were dull, with a low presence of food such as fish and fish products, milk and dairy products, leguminous plants and seasonal fruit and vegetables. Fatty food was mainly used. A more diverse menu should include fish and fish products, fresh seasonal fruit and vegetables, low fat dairy products, low fat turkey and veal, and integral food grain products. Nutritional changes would have a positive impact on the course and complications of chronic diseases in the elderly. General hospital Zadar 2007-01-20 text pdf http://hrcak.srce.hr/10439 http://hrcak.srce.hr/file/16023 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.36 No.1-2; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:10712 2008-06-03 journal:31

Analiza indikatora morbiditeta, mortaliteta i potrošnje lijekova u Zagrebu Indicators of morbidity, mortality and drug utilization in the city of Zagreb Polić-Vižinitin, Marina Tripković, Ingrid Štrban-Štok, Zlatica Štimac, Danijela Čulig, Josip Starenje, smrtnost, pobol, zdravstvene potrebe i zahtjevi aging, mortality, morbidity, health care needs and demands Starenje stanovništva utječe na tip pobola i razloge zbog kojih se traži liječnička pomoć. Cilj je rada analizom zdravstvenih indikatora i izvanbolničke potrošnje lijekova procijeniti zdravstveno stanje i potrebe stanovništva u Zagrebu. Koriste se podaci vitalne statistike i zdravstveno-statističkih istraživanja. Analizira se potrošnja lijekova s režimom izdavanja na recept, koristeći ATK sustav i definirane dnevne doze Svjetske zdravstvene organizacije. Testiranje postavljenih hipoteza izvedeno je primjenom X2 - testa, za ocjenu statističkih značajnosti u morbiditetu različitih dobnih skupina. Najveći indeks korištenja primarne zdravstvene zaštite bio je iznad 65 godina (98,8 %), uz 7,5 izvršenih pregleda po stanovniku. Hipertenzivne bolesti su značajno zastupljene u najstarijoj populaciji u odnosu na ostale starosne skupine (X2 = 27,3; p<0,05), kao i bolesti intervertebralnih diskova i ostalih dorzopatija (X2 = 13,43; p<0,05). Psiholeptici su tijekom 2001. godine, prema broju DDD, na prvom, pripravci koji djeluju na reninangiotenzinski sustav na drugom, blokatori kalcijevih kanala na trećem mjestu propisanih skupina lijekova. U skupini psiholeptika prevladavaju benzodiazepini. Dvije najznačajne skupine uzroka smrti, cirkulacijske bolesti i neoplazme, bilježe u Zagrebu od 1971. do 2001. stalan rast (cirkulacijske bolesti 43,7 %; neoplazme 55,1%). Starenje stanovništva reflektira se porastom stope ukupnog mortaliteta te padom standardiziranog mortaliteta po dobnim skupinama. U promatranom razdoblju u porastu je mortalitet uzrokovan cirkulacijskim i malignim bolestima, duševnim, te endokrinim bolestima pa javnozdravstvene prioritete treba usmjeriti na prevenciju kroničnih bolesti. Podaci o prekomjernoj potrošnji benzodiazepina i skupih antihipertenziva ukazuju na potrošnju trajne edukacije liječnika u svrhu racionalnijeg propisivanja lijekova. The aging of the population influences the pattern of morbidity and the reasons for seeking medical help. The aim of the study was to assess the health condition and needs of the elderly citizens of Zagreb by analysis of the respective health indicators and outpatient drug utilization. Data provided by vital statistics and health statistics were used in the study. The analyses included prescription drug utilization using the World Health Organization ATC system and defined daily doses (DDD). The study hypothesis was tested by x2-test, to determine statistical significance for the morbidity in various age groups. The highest index of using primary health care was recorded in the >65 age group (98,8%) with 7.5 examinations per inhabitant. The rate of hypertensive diseases was by far greater in the oldest age group as compared with other age groups (x2=27.3; p <0.005), which also held for intervertebral disk and other back pathology (x2=13.43; p<0.05). According to DDD, psycholeptics were the most prescribed drugs, immediately followed by the agents acting upon the renin-angiotensin system, and calcium channel blockers in 2001. Benzodiazepines predominated in the group of psycholeptics. The two major causes of death, circulatory diseases and neoplasms, were on a steady increase from 1971 till 2001 (by 43,7% and 55,1%, respectively). The aging of the population entails an increasing rate of total mortality and a decreasing rate of standardized mortality according to age groups. During the study period, the mortality due to circulatory and malignant diseases, mental and endocrine disorders was on an increase, thus public health priorities should be directed towards prevention of chronic diseases. Data on the excessive utilization of benzodiazepines and expensive antihypertensive agents point to the need of continuing rational drug prescribing education of physicians. General hospital Zadar 2007-01-20 text pdf http://hrcak.srce.hr/10712 http://hrcak.srce.hr/file/16417 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.36 No.1-2; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:10722 2008-06-03 journal:31

Upućivanje bolesnika na dezintometriju u fizijatrijskim ambulantama Directing patients to densitometry in physiatric surgeries Šakić, Davorin Badovinac, Olga Delija, Alboran Šantek, Ivan Amerl-Šakić, Vjekoslava Dezintometrija, fizijatrijska ambulanta densitometry, physiatric surgeries Cilj ove dvogodišnje prospektivne studije bila je usporedba broja i T-vrijednosti dezintometrija kod bolesnika u četiri fizijatrijske ambulante, te broj i lokalizacija prijeloma nakon minimalne traume u odnosu na graničnu T-vrijednost za osteoporozu. Muški su bolesnici na dezintometriju upućivani znatno rjeđe (7,36 %) od ženskih (92,64%), dok su prema dobi neznatno češće zastupljeni bolesnici stariji od 65 godina života (51,39 %) u odnosu na mlađe (48,615%). Skoro 3 puta veći broj prijeloma kralješaka je u skupini s osteoporozom nego u skupini osteopenije. U odnosu na graničnu T-vrijednost od -2,5 SD ostali prijelomi nakon minimalne traume neznatno su češći kod osteoporotičnih 57,14 % od onih s osteopenijom 42,86 %. Učestalost od 110 prijeloma na 503 dezintometrije u ovoj studiji iznosi 21,87 % i neznatno je viša od vrijednosti koja se obično uzima kao europski prosjek, ali još uvijek u granicama od 20 do 25 %, koliko iznosi svjetski prosjek. The purpose of this two-year prospective study, which was conducted in four physiatric surgeries, was the comparsion of quantity and T-values of densitometry in patients, and quantity and localization of fractures after a minimal traumatic incident in relation with border T-value for osteoporosis. Female patients were more frequently sent to densitometry than male patients (92,64% : 7,36%). Patients older than 65 were slightly more often represented than the younger ones (51,39% : 48,61%). We observed fracture of the vertebra in the group with osteoporosis almost three times more often than in the group with osteopenia. In relation with the border T-score, that is -2,5 SD, other fractures, after minimal traumatic incidents, were slightly more common in osteoporotic patients than in those with osteopenia (57,14% : 42,86%). The frequency of 110 fractures in 503 densitometries in this study, or 21,87%, is slightly higher than the European average, but it is still within the limits of the world average (20-25%). General hospital Zadar 2007-01-20 text pdf http://hrcak.srce.hr/10722 http://hrcak.srce.hr/file/16436 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.36 No.1-2; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:10728 2008-06-03 journal:31

Najčešći kontaktni alergeni u bolesnika s kontaktnim dermatitisima u području Slavonskog Broda The most frequent contact allergens in patients with contact dermatitis in the Slavonski Brod region Tomljanović-Veselski, Mirna Jovanović, Ivana Kontaktni alergijski dermatitis, etiologija, epikutani test contact allergic dermatitis, etiology, epicutaneous (patch) test Cilj je ovog rada bio prikazati rezultate epikutanog testa standardnom serijom alergena na Odjelu za kožne i spolne bolesti Opće bolnice "Dr. Josip Benčević" u Slavonskom Brodu tijekom protekle dvije godine te ih usporediti s rezultatima testiranja u Alergološkoj ambulanti Klinike za kožne i spolne bolesti u Zagrebu i rezultatima testiranja brojnih inozemnih autora. Rezultati epikutanog mjesta standardnom serijom od 20 alergena uspoređivani su između Klinike za kožne i spolne bolesti, te Opće bolnice "Dr. Josip Benčević". Kroz 24 mjeseca ispitanici alergološke ambulante Odjela za kožne i spolne bolesti u Slavonskom Brodu testirani su standardnom serijom. Na Klinici za kožne i spolne bolesti na istu seriju alergena testirani su bolesnici u petogodišnjem periodu. Od naših bolesnika 172 su imala pozitivne reakcije, od toga 88 jednu pozitivnu reakciju, 60 dvije pozitivne reakcije, te 24 tri i/ili više pozitivnih reakcija. Najčešće pozitivne reakcije imali smo na nikal sulfat, kao što je vidljivo i u rezultatima Alergološke ambulante Klinike za kožne i spolne bolesti. Statistički značajne pozitivne reakcije zabilježene su kod tri alergena: nikal sulfat, kobalt klorid i smjesa mirisa. U našem dvogodišnjem praćenju učestalost pozitivnih epikutanih testova na nikal sulfat, formaldehid, Quarternium 15, te timerosal je podjednaka, dok je kod smjese mirisa, neomycin sulfata, kobalt klorida i peruanskog balzama nešto niža. The goal of this paper is to show the results of the epicutaneous (patch) test with standard allergens at the Department of Dermatology and Venerology of General Hospital "Dr. Josip Benčević" in Slavonski Brod in the past two years. The goal is also to compare these results with the results from the Allergological Infirmary in the Department of Dermatology and Venerology in Zagreb University Hospital Center. The results of patch testing with 20 standard allergens from General Hospital "Dr. Josip Benčević" and from the Department of Dermatology and Venerology in Zagreb University Hospital Center have been compared. In our "Dr, Josip Benčević" Hospital patients were tested during 2004 and 2005. In the Department of Dermatology and venerology in Zagreb University Hospital Center patients were tested in a five-year period. There were 172 patients with positive test results, out of which 88 had one positive reaction, 60 had two positive reactions, and 24 had three or more positive reactions. NiSO4 (or Nickel-sulfate) was the most common cause for the positive test reaction. The same compound was also the most common cause in the Department of Dermatology and Venerology in Zagreb University Hospital Center. Statistically significant positive reactions were present in three allergens: nickel sulfate, cobalt chloride and fragrance mix. In the two-year follow up (monitoring) frequency of epicutaneous (patch) test positive reactions on nickel sulfate, formaldehyde, Quarterinum-15 and Thimerosal is almost the same, while the frequency of positive reactions on fragrance mix, neomycin sulfate, cobalt chloride and balsam of Peru is somewhat lower. General hospital Zadar 2007-01-20 text pdf http://hrcak.srce.hr/10728 http://hrcak.srce.hr/file/16447 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.36 No.1-2; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:12259 2008-06-03 journal:31

Prim.dr.Roman Jelić - patrijarh zadarske medicine Prim.dr. Roman Jelić - Zadar medicine patriarch Jamnicki Dojmi, Mirko povijest medicine, rendgenologija, zdravstvene ustanove, zdravstvene udruge, zdravstveno prosvjećivanje, znanstvena publicistika, XX stoljeće history of medicine, radiology, medical institutions, medical associations, health education, 20 th century U kratkom prikazu ocrtan je životni put i djelo dr. Romana Jelica. Autor se najprije osvrce na ishodišnu tocku – Mali Iž – iz koje je ponikao lik ustrajnoga, radišnog, nadarenog mladica rodenog u ribarskoj obitelji. Opisuje nadalje njegov život koji zbog povijesnih okolnosti nalikuje svojevrsnoj odiseji. U punom životnom zamahu, u fazi zrele i kompleksne kreativnosti bavi se strukom, poviješcu i poviješcu medicine, demografskim istraživanjima. Opisuje se njegov strucni i društveni angažman usmjeren na promicanje rendgenologije, poboljšanje radnih uvjeta, organizaciju zdravstva i preventive, snažnije povezivanje medicinskih djelatnika i organiziranje njihove dodatne edukacije. Autor se osvrce na Jelicevo utemeljenje Lige za brobu protiv raka, Onkološkog dispanzera, zadarske podružnice Zbora lijecnika Hrvatske, medicinskog casopisa Medica Jadertina, obnašanje brojnih društvenih i kulturno-prosvjetiteljskih funkcija, kao i na njegovu znanstvenu i publicisticku djelatnost. Kao medicinara široke kulture, velikog raspona interesa, klasicnog osjecaja za komplementarne znanstvene discipline i za sintezom kulturno-povijesnodemografskih cinjenica, autor ga svrstava u patrijarhe zadarskoga medicinskog kruga, te proglašava nestorom zadarske povijesti medicine. In this short review the author describes the life and work of dr. Roman Jelic. First of all the author looks back to the point of departure – Mali Iž – from where arose the figure of a hard-working and talented young boy born into a fisherman family. Then he depicts the doctor's life that resembles an odyssey of its kind. In full swing of life, at the point of mature and complex creativity, he pursues his profession, history, the history of medicine and demographic research. Later comes the description of his professional and social engagement aimed to encourage radiology, to improve working conditions, health system and prevention, to strengthen the connection among medical workers and organize their further education. The author refers to the doctor's contribution to the foundation of The League Against Cancer, The Oncologic Dispensary, the Zadar branch of The Medical Association of Croatia, the medical magazine Medica Jadertina as well as his activity in numerous social, cultural and educational activities. As a medical worker of great culture, wide span of interests, classic feeling for complementary scientific disciplines and synthesis of cultural, historical and demographic facts, the author places the physician in the rank of Zadar medical region patriarchs. The author considers him as the Zadar history of medicine nestor. General hospital Zadar 2006-09-18 text pdf http://hrcak.srce.hr/12259 http://hrcak.srce.hr/file/18880 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.35 No.Suplement; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:12260 2008-06-03 journal:31

Otok kao motiv i inspiracija u djelu Romana Jelića The island as motive and inspiration in the work of Roman Jelić Fatović-Ferenčić, Stella otok Iž island of Iž Autorica se usredotocuje na otok kao ishodišni motiv i inspiraciju u djelu Romana Jelica. Istice vrijednost arhivskih i ostalih Jelicevih istraživanja u cuvanju i prikupljanju hrvatske otocne baštine u sklopu koje je posebna pozornost posvecena istraživanjima povijesti medicine otoka Iža. The author points out the island as motive starting point and inspiration in the work of Roman Jelic. He emphasizes the archive and other values of the researches made by Jelic on the preservation and collection of island heritage with special emphasis on the Island of Iž history of medicine researches. General hospital Zadar 2006-09-18 text pdf http://hrcak.srce.hr/12260 http://hrcak.srce.hr/file/18881 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.35 No.Suplement; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:12261 2008-06-03 journal:31

Roman Jelić i nahodišta Roman Jelić and orphanages Perović, Slavko Roman Jelić, nahodišta, velik doprinos Roman Jelić, orphanages, significant contribution Medu autorima koji su pisali o nahodištima u Dalmaciji, neobicno je velik doprinos zadarskog lijecnika i povjesnicara Romana Jelica. Njegov je rad znatno obogatio ovo podrucje. Posebno su važni njegovi prilozi o životu nedonošcadi, nacinu krštenja, nakaradnim imenima, barbarskom žigosanju, siromašnoj prehrani, ogromnoj smrtnosti, lošoj sudbini itd. U svojem radu Jelic pruža znatne podatke ne samo o nahodištu u Zadru vec i o drugim dalmatinskim nahodištima. Roman Jelic, Zadar‘s physician and historian, made a significant contribution to the community of authors who wrote about orphanages in Dalmatia. His work significantly enriched this subject matter. Especially important was his work on the life of orphaned children, baptism practices, bizarre naming, barbaric branding, poor nutrition, enormous mortality rate, uncertain destiny, etc. In his work, Jelic presents significant data, not only about orphanages in Zadar, but also about other Dalmatian orphanages as well. General hospital Zadar 2006-09-18 text pdf http://hrcak.srce.hr/12261 http://hrcak.srce.hr/file/18882 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.35 No.Suplement; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:12262 2008-06-03 journal:31

Dvije medikohistorijske teme u radovima dr. Romana Jelića Two medico-historical themes in the works of dr. Roman Jelić Jamnicki Dojmi, Mirko povijest medicine, obitelj Pinelli, liječnici, epidemije kuge, Dobropoljci, zadarski lazareti history of medicine, Pinelli family, physicians, plague epidemic, Dobropoljci, Zadar lazarets Clanak je koncipiran kao osvrt na dvije medikohistorijske teme koje obraduje Roman Jelic. Prva tema obraduje osam lijecnika iz zadarske obitelji Pinelli, druga se odnosi na epidemiju kuge u Dobropoljcima iz 1744., te na kužne epidemije koje su u rasponu stoljeca prohujale Zadrom. Premda su o lijecnicima iz obitelji Pinelli pisane podatke iznosili i drugi povjesnicari medicine, Jelic je prvi u nas pisao o prvom iz te obitelji (praocu), doseljeniku iz Italije, dr. Petru Pinelliju. S ostalih sedam lijecnika, o kojima Jelic podastire obilje argumentiranih podataka, Jelic ih tako sve okuplja na jednome mjestu. U svom radu Kuga u Dobropoljcima 1744 Jelic iznosi provjerene podatke o vremenu nastanka kuge i njezinome tijeku, te na plastican nacin ocrtava tehnologiju življenja tijekom epidemije, kao i organiziranje profilaktickih mjera za sprjecavanje daljnjeg širenja pošasti. U clanku Zadarske kuge i lazareti obradio je dvadeset i pet kužnih epidemija, od prve, koja je planula u Carigradu i u Zadar prispjela godine 545., do posljednje, koja je pohodila Zadar godine 1678. Zasebna je draž ovih Jelicevih radova u išcitavanju brojnih, pomno prikupljenih bilješki. Materijal naveden u fusnotama, zapravo, poseban je rad u strucnom prikazu i funkcionira gotovo kao prica u prici. The article is conceived as a retrospection of two medico-historical themes that dr. Roman Jelic deals with. The former elaborates the eight doctors in the Pinelli family, while the latter deals with the plague epidemic in Dobropoljci in 1744, as well as with infectious epidemics which appeared in the Zadar region throughout a century. Although other medical historians published their works about the doctors in the Pinelli family, dr. Jelic was the first in our country to write about the first one, an immigrant from Italy, dr. Petar Pinelli. Together with the other seven about whom he gives a lot of arguments, dr. Jelic closes the circle and gathers them all in one place. In his work The plague in Dobropoljci in 1744 dr. Jelic brings out the facts about the origin of the plague and its course. There he vividly describes the living conditions during the epidemic, as well as the organising of prophylactic measures of preventing the further spreading of the plague. In his article Zadar plagues and lazarets he works out twenty-five infectious epidemics, starting with the first which broke out in Constantinople and arrived in Zadar in 545, and finishing with the one that came to Zadar in 1678. The peculiar charm of the doctor's works lies in the possibility of reading his carefully collected notes. The material mentioned in the footnotes is actually a separate work of a professional account, and it works as a story within the story. General hospital Zadar 2006-09-18 text pdf http://hrcak.srce.hr/12262 http://hrcak.srce.hr/file/18883 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.35 No.Suplement; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:12263 2008-06-03 journal:31

Crtice iz života moga oca Jelić, Ivan General hospital Zadar 2006-09-18 text pdf http://hrcak.srce.hr/12263 http://hrcak.srce.hr/file/18884 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.35 No.Suplement; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:12264 2008-06-03 journal:31

Akcija dr. Rudolfa Battare u Ninu god. 1902., prvi sustavni pokušaj borbe protiv malarije u Hrvatskoj Dr. Rudolf Battara operation in Nin in 1902. the first systematic battle attempt against malaria in Croatia Dugački, Vladimir malarija, medikamentna profilaksa kininom malaria, prophylactic medicamentous treatment Otkrice uzrocnika malarije (Laveran, 1880) i nacina prenošenja te bolesti (Ross i Grassi, 1898) otvorilo je nove perspektive u sprjecavanju malarije. Mladi je zadarski lijecnik Rudolf Battara god. 1902. u Ninu, gradicu jako pogodenom malarijom, proveo prvi kontrolirani terenski pokus medikamentne profilakse kininom citavog pucanstva Akcija se pokazala uspješnom i sljedecih je godina provodena i u drugim mjestima Dalmacije. Uz to su poduzeti opsežni asanacijski radovi na regulaciji rijeka i isušivanju mocvara, no nije se dovoljna pozornost posvetila malim asanacijama (isušivanju lokava i sanaciji bunara i cisterni). The discovery of the agent causing malaria (Laveran, 1880) and of the mode of transfer of this disease (Ross and Grassi, 1898) opened up new perspectives and paths concerning its control. A young physician from Zadar, Rudolf Battara, carried out a field study in 1902 in Nin, a small Dalmatian town heavily stricken by malaria, in the attempt to eradicate the disease from the region by applying a prophylactic medicamentous treatment to the general population. In the following years the action spread almost through every part of Dalmatia. General hospital Zadar 2006-09-18 text pdf http://hrcak.srce.hr/12264 http://hrcak.srce.hr/file/18885 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.35 No.Suplement; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:12265 2008-06-03 journal:31

Sveci zaštitnici od zmijskog ujeda u hrvatskoj etnomedicinskoj tradiciji Saints-protectors from snake bites in the Croatian ethnomedical tradition Škrobonja, Ante Muzur, Amir Hrvatska, etnomedicina, religija, zmije Croatia, ethnomedicine, religion, snakes Cilj: Registrirati svece kojima se u kršcanskoj tradiciji u Hrvatskoj pripisuje moc zaštite od zmijskog ujeda te objasniti njihovu medusobnu vezu ili simbolicno znacenje. Metode: Obrada literature koja obraduje hagiografije svetaca, sakralnu ikonografiju uz istraživanje na terenu kroz obilazak sakralnih objekata i etnografskih muzeja te razgovor s ljudima koji poznaju pucku tradiciju. Rezultati: Iz bogate hrvatske sakralno-etnografske baštine, kao svojevrstan specifikum, izdvojeno je sedam svetaca za koje se u puku tradicionalno vjeruje da imaju zaštitnicku moc od ujeda otrovnih zmija. To su: apostoli Petar i Pavao, Ivan Evandelist, Juraj, Hilarije, Hubertus i Gaudencije Osorski. Uz kratke hagiografske naznake dana su i objašnjena o vezi pojedinog sveca sa zmijama. Zakljucak. Prezentirani primjeri pokazuju kako se interdisciplinarnim pristupom sakralnoj umjetnosti i tradiciji može doci i do brojnih drugih spoznaja koje nadilaze uske religijske poruke. U ovom primjeru to su prilozi povijesti medicine u najširem smislu. Aim. To register the saints in the Croatian Christian tradition to which protective powers from snake bite are ascribed, and explain their interrelations or symbolic meanings. Methods. The analysis of literature treating saints' hagiographies, sacral iconography and liturgy. Field work (visiting sacral objects and ethnographic museums, interviews with folk-tradition connoisseurs). Results. Seven saints, as a specificum sui generis, have been chosen from the rich Croatian sacralethnographic heritage, for which the folk traditionally believes to have protective power from poisonous snake bites: the Apostles Peter and Paul, John the Baptist, George, Hilarius, Hubertus, and Gaudentius. Besides short hagiographic data, explanations have been provided on the relations between the saints and the snakes. Conclusion. The presented examples demonstrate how interdisciplinary approach to sacral art and tradition can result in a new knowledge surpassing religious messages and entering the field of medical history in its broadest sense. General hospital Zadar 2006-09-18 text pdf http://hrcak.srce.hr/12265 http://hrcak.srce.hr/file/18886 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.35 No.Suplement; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:12532 2008-06-03 journal:31

Operativni pristup perforativnoj povrjedi oka s traumatskom kataraktom kod djece-prikaz slučaja Surgical approach to perforated eye injuries with traumatic cataract in children-a case report Čanović, Samir Jusufović, Vahid Nuhbegović, Sabina traumatska katarakta, perforativne traume prednjeg segmenta, povrjede oka kod djece traumatic cataract; front segment perforated trauma; ocular trauma in children Cilj rada bio je pokazati naša iskustva u zbrinjavanju perforativnih povrjeda oka kod djece. Radilo se o povrjedi oka staroj 24 sata, s traumatskom kataraktom. Neposredno poslije prijma pristupa se operativnom zahvatu u opcoj anesteziji metodom fakoemulzifikacije s ugradnjom intraokularne lece (IOL) u stražnju sobicu. Postoperativni tijek protjece uredno. Vidna oštrina prvi postoperativni dan bila je 0,4 uz normalan intraokularni tlak i bez patoloških promjena na stražnjem segmentu oka. Nakon 2 mjeseca oštrina vida je 0,8, ali uz prisutnost iridolentalnih sinehija (iris-IOL) i nepravilnost zjenice. Ponovno se odlucimo na operativni zahvat u smislu korekcije pupile i prevencije razvoja sekundarnoga glaukoma. Operativno nakon kornealne paracenteze uradi se sinehioliza zjenice iris manipulatorom i zjenica formira u centralnoj projekciji. Postoperativni tijek protjece uredno, s vidnom oštrinom od 0,8 u prvom postoperativnom tjednu i 0,9-1,0 tri mjeseca poslije operacije. Prognoza za vidnu oštrinu kod pacijenta je dobra, uz redovite kontrole zbog mogucnosti opacifikacije stražnje kapsule lece i eventualnoga sekundarnog glaukoma. Ozljede oka spadaju u teške povrjede zbog nepredvidivosti posljedica traume. Osobit problem cine djecje ozljede oka, kod kojih je bitan i socioekonomski aspekt koji determinira i njihovu buducnost. Kirurški pristup u zbrinjavanju povrjeda kod djece cesto je individualan i ovisan o iskustvu i kirurškoj vještini samog operatora. The aim of this work is to show our experiences in eye injury care in children. The case involved a 24- hour-old eye injury with traumatic cataract. Immediately after having been admitted in hospital, surgery was performed, under complete anaesthesia, using the phacoemulsification method by implanting an IOL in the posterior chamber. The postoperative development was regular. The sight definition, after the first day of surgery, was 0.4 accompanied by normal intraocular pressure without pathological changes in the posterior eye segment. Two months later, the sight definition was 0.8, with the presence of iridolental synechia (iris-IOL) and pupil irregularity. We decided to perform surgery once more to correct the pupil and prevent secondary glaucoma development. After corneal paracentesis, pupil synechiosis was performed with an iris manipulator and the pupil in central projection. The postoperative period was regular with 0.8 sight definition in the first post-operative week, and 0.9 and 1.0 three months following surgery. The patient's sight definition prognosis was good and control tests were regular, due to the possibility of posterior lens capsule opacification and eventual secondary glaucoma. Eye injuries relate to serious injuries, due to the unpredictability of trauma consequences. Child eye injuries are a particular problem, considering the socioeconomic aspect that determines their future importance. The surgical approach in child injury care is frequently individual, and it depends on the experience and skill of the surgeon himself. General hospital Zadar 2007-06-15 text pdf http://hrcak.srce.hr/12532 http://hrcak.srce.hr/file/19311 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.36 No.3-4; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:12536 2008-06-03 journal:31

Nickel allergy frequency in a ten-year period in Karlovac County Učestalost alergije na nikal u desetogodišnjem razdoblju u Karlovačkoj županiji Kuljanac, Ilko Knežević, Eva Cvitanović, Hrvoje nickel allergy, epicutaneous test, allergic contact dermatitis, atopic dermatitis nikal; alergija; epikutani test; kontaktni alergijski dermatitis; atopijski dermatitis The aim of this study was to evaluate the role of nickel sulfate as a cause of allergic contact dermatitis. We revised the clinical records of out-coming patients with allergic contact dermatitis (ACD) and atopic dermatitis (AD) clinical diagnosis at the Department of Dermatology and Venerology of Karlovac General Hospital during the 1994–2005 study period. There were 2828 patients, f: 2033 (71.9%), m: 795 (28.1%) ranging from 7-81, mean age 36. The epicutaneous patch test with 5% nickel sulfate (Institute of Immunology, Zagreb, Croatia) was done. Out of all patients (2828), 373 (13.1%) showed positive epicutaneous patch test reaction to nickel sulphate. Taking into consideration gender, out of all female patients, the nickel positive patch test was recorded in 11.7% patients, while the result in the males was 1.4%. A statistical difference between positive results in females and males was significant (p < 0.05). In order to determine the importance of atopic constitution in nickel sensitivity, patients were divided into two groups: 1. Patients with ACD: 2513 patients, f: 1806 (71.8%), m: 707 (28.2%), ranging from 8-81, mean age: 39.2, 2. Patients with AD (according to Hanifin and Rajka criteria, 1982 (5): 315 patients, f: 227 (72.1%), m: 88 patients (27.9%), ranging from 7-78, mean age: 36.3. ACD patients in the first group resulted in 332 positive tests (13.2%), while in the second group (atopic patients) 41 resulted positive (13.0%). The difference is not statistically significant (p > 0.05). It is concluded that nickel is the most frequent allergen which affects the younger female. Atopic constitution does not have any influence on nickel sensitivity. It is equally frequent in persons with and without atopic constitution. Cilj rada bio je procjena uloge nikla u nastanku kontaktnog alergijskog dermatitisa (KAD). Obradeni su rezultati epikutanog testiranja s 5% nikal sulfatom (Imunološki zavod, Zagreb), tijekom 1994.-2005. godine, bolesnika s KAD-om i atopijskim dermatitisom (AD). Od ukupno 2828 bolesnika ukljucenih u studiju, ž: 2033 (71,9%), m: 795 (28,1%), starosti od 7 do 81 godine, prosjecne starosti: 36,6 godina; 373 (13,1%) bolesnika imalo je pozitivan epikutani test na nikal. S obzirom na spol, od svih osoba ženskog spola ukljucenih u studiju 11,7% imalo je pozitivan epikutani test na nikal, dok je u osoba muškog spola pozitivan epikutani test bio u 1,4% bolesnika, što je statisticki znacajna razlika (p < 0,05) U cilju odredivanja znacenja atopijske konstitucije u nastanku senzibilizacije na nikal, pacijenti su bili podijeljeni u dvije skupine: 1. bolesnici s KAD-om: 2513 bolesnika, ž: 1806 (71,8%), m: 707 (28,2%), dobi od 8 do 81 godine, prosjecne dobi: 39,2 god., 2. bolesnici s AD-om (prema kriterijima Hanifin i Rajka, 1982 (5): 315 bolesnika, ž: 227 (72,1%), m: 88 bolesnika (27,9%), dobi 7-78 godina, prosjecne dobi: 36,3 god. U prvoj skupini (bolesnici s KAD-om) bila su 332 pozitivna testa (13,2%), a u skupini 2 (bolesnici s atopijom) bio je 41 pozitivan test 13,0%. Razlika nije statisticki znacajna (p > 0,05). Zakljucili smo da se alergija na nikal najcešce javlja u mladih osoba ženskog spola. Atopijska konstitucija nema utjecaja na pojavu senzibilizacije na nikal. Ona se javlja s jednakom ucestalošcu u osoba s atopijskom konstitucijom i bez nje. General hospital Zadar 2007-06-15 text pdf http://hrcak.srce.hr/12536 http://hrcak.srce.hr/file/19317 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.36 No.3-4; ISSN 0351-0093 (Print) en

oai:hrcak.srce.hr:12538 2008-06-03 journal:31

Prevalencija psorijaze i psorijatičnog artritisa u dvije fizijatrijske ambulante Psoriasis and psoriatic arthritis prevalence in two physiatric surgeries Šakić, Davorin Badovinac, Olga Delija, Alboran Amerl-Šakić, Vjekoslava Gerakarov, Stevan Andrlon-Bušić, Dubravka Soldo-Jureša, Dragica psorijaza, psorijatični artritis, učestalost psoriasis; psoriatic arthritis; frequency Psorijaticni artritis manifestira se kao kronicni recidivirajuci seronegativni asimetricni erozivni oligoartritis ili poliartritis pridružen psorijaticnim promjenama na koži. Prema podatcima iz literature prevalencija psorijaze u opcoj populaciji Hrvatske varira izmedu 1 i 2%. Cilj ovog rada bio je ustanoviti ucestalost psorijaze i psorijaticnog artritisa u dvije fizijatrijske ambulante KB Dubrava. Od 1. 1. do 31. 12. 2004. pregledano je i lijeceno fizikalnom terapijom 4747 pacijenata zbog tegoba sustava za kretanje. Bolesnici su bili iz sjeveroistocnog dijela Zagreba i okolnih gradica i sela sa sveukupnom populacijom od 150.000 stanovnika. Sve pacijente sa suspektnom psorijazom pregledao je dermatolog. Statisticka analiza ukazuje da je prevalencija psorijaze 1,03%, te da su oba spola podjednako zahvacena (27 muškaraca i 22 žene). Prevalencija artritisa u pacijenata sa psorijazom je 14,29% i signifikantno je veca u muškaraca (5) nego u žena (2). Psoriatic arthritis is a chronic and recurring seronegative asymetric and erosive oligoarthritis or polyarthritis characterized by psoriatic skin changes. According to literature data, psoriasis prevalence in the general population of Croatia varies between 1% and 2%. The aim of this study was to determine the prevalence of psoriasis and psoriatic arthritis in two physiatric surgeries in Dubrava Clinical Hospital. A total of 4747 patients were examined and treated with physical therapy for locomotor system disturbances from January 1st to December 31st, 2004. Patients came from the north-eastern part of Zagreb and the nearby towns and villages with an overall population of 150,000. All patients with suspicious psoriasis were examined by a dermatologist. Statistical analysis showed that the prevalence of psoriasis is 1.03%, and that the two sexes were equally involved (27 male and 22 female). The prevalence of arthritis in psoriatic patients was 14.29% and significantly higher in men (5) than in women (2). General hospital Zadar 2007-06-15 text pdf http://hrcak.srce.hr/12538 http://hrcak.srce.hr/file/19319 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.36 No.3-4; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:12550 2008-06-03 journal:31

Neke odrednice zadovoljstva zdravljem odraslih osoba Some health satisfaction determinants among adults Tucak, Ivana Nekić, Marina zadovoljstvo zdravljem, zaposlenost, bračni status, roditeljstvo, socijalni odnosi, odrasla dob health satisfaction; employment; marital status; parenthood; social relations; adulthood Cilj je ovoga istraživanja bio ispitati zadovoljstvo zdravljem osoba mlade, srednje i starije odrasle dobi. Takoder smo ispitivali odnos zadovoljstva zdravljem s razlicitim sociodemografskim varijablama (npr. spol, godine školovanja, status zaposlenosti i dr.), procjenama važnosti zaposlenosti, bracnog statusa i roditeljstva, te s procjenama zadovoljstva roditeljskom ulogom i socijalnim odnosima u uzorku ispitanika odrasle dobi. U istraživanju je sudjelovalo 200 osoba oba spola u dobi od 25 do 75 godina iz razlicitih podrucja Hrvatske. Rezultati analiza na ukupnom uzorku pokazali su da se muškarci i žene ne razlikuju znacajno s obzirom na zadovoljstvo zdravljem. Ispitanici mlade odrasle dobi (u dobi od 25 do 40 godina, N = 72) i ispitanici srednje odrasle dobi (od 41 do 60 godina, N = 90) bili su znacajno zadovoljniji svojim zdravljem u odnosu na ispitanike starije odrasle dobi (stariji od 60 godina, N = 38). Zaposleni su bili zadovoljniji svojim zdravljem u odnosu na nezaposlene i umirovljenike. Rezultati regresijske analize pokazali su da su se važnost zaposlenosti i zadovoljstvo socijalnim odnosima pokazali znacajnim prediktorima zadovoljstva zdravljem u ovom uzorku odraslih osoba. The aim of this research was to examine health satisfaction among younger, middle-aged and older adults. We also examined the relations of health satisfaction with different sociodemographic variables (e.g. sex, years of education, employment status), importance of employment assessment, marital status and parenthood, and satisfaction assessment with parental role and social relations in the sample of adult persons. 200 adults, men and women, 25 to 75 years of age, from different parts of Croatia participated in the research. The results of the analyses in all the examples showed that men and women didn't differ significantly regarding to health satisfaction. Younger adults (from 25 to 40 years, N = 72) and middle-aged adults (from 41 to 60 years, N = 90) were significantly more satisfied with their health compared to older adults (older than 60, N = 38). The employed were more satisfied with their health than the unemployed and retired. The results of regression analyses showed that the importance of being employed and satisfaction with social relations were significant predictors of health satisfaction in this sample of adults. General hospital Zadar 2007-06-15 text pdf http://hrcak.srce.hr/12550 http://hrcak.srce.hr/file/19341 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.36 No.3-4; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:12552 2008-06-03 journal:31

Kakvoća prehrane u studentskom centru u Splitu The quality of nutrition in Split student center Ćurin, Katja Knezović, Zlatka Marušić, Jadranka prehrana studenata, prehrambeni standardi, edukacija, prevencija Nacin prehrane znacajno utjece na mentalnu i fizicku kondiciju studenata. Adekvatan unos visokovrijednih bjelancevina, vitamina (osobito B-skupine) i minerala regulira važne metabolicke procese u organizmu, te utjece na kognitivne funkcije bitne u procesu ucenja kod studenata. Cilj rada bio je ispitati kvalitetu prehrane studenata u Splitu u odnosu na preporucene vrijednosti radi predlaganja mjera za unapredenje. U razdoblju od 1999. do 2005. godine u Nastavnom zavodu za javno zdravstvo u Splitu ispitana je prehrambena i energetska vrijednost 71 dnevnog obroka uzetih jedanput mjesecno metodom slucajnog izbora u Studentskom centru u Splitu. Analizirane vrijednosti usporedene su sa zadanim normativima. Ispitana je ucestalost korištenja namirnica iz osnovnih skupina. Prehrambene i energetske vrijednosti dnevnih obroka tijekom sedam godina ispitivanja manje su od zadanih normativa. Odstupanja su najveca za masti (do 40%) i bjelancevine (34%). Udio kruha u ukupnoj energetskoj vrijednosti je u prosjeku oko 40%, dakle nešto više od zadanih preporuka. Jelovnici su jednolicni, slabo su zastupljene namirnice poput ribe, mlijeka i mlijecnih proizvoda, mahunarki, te sezonskog voca i povrca. Utvrdeni propusti trebaju se korigirati zbog utjecaja prehrane na zdravlje i proces ucenja kod studenata. The mental and physical condition of students is highly influenced by their nutrition. Adequate intake of highly important proteins, vitamins (B-group especially) and minerals regulates not only a number of important metabolic processes in the body, but it influences the cognitive functions essential to the learning process in students as well. The aim of this paper was to examine the student nutrition quality in Split in relation to recommended values for proposing measures of improvement. Using the random selection method, food and energetic value of 71 daily meals taken on a monthly basis from Split Student Center was examined from 1999 to 2005 in Split Public Health Teaching Institute. Analyzed values were compared with prescribed standards. The frequency of staple food usage was also examined. Food and energetic values of daily meals were lower than the prescribed standards during a seven-year examination period. Fats and proteins were subject to peak deviations, up to 40% and up to 34.0% respectively. A mean portion of bread in total energetic value amounted to 40%, thus slightly exceeding the recommended values. The menus were dull, with a low presence of food such as fish, milk and dairy products, leguminous plants and seasonal fruit and vegetables. The omissions determined should be corrected because of the nutritional impact on the health and learning process in students. General hospital Zadar 2007-06-15 text pdf http://hrcak.srce.hr/12552 http://hrcak.srce.hr/file/19343 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.36 No.3-4; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:12613 2008-06-03 journal:31

Proces umirovljenja: pokušaj provjere Atchleyeva modela prilagodbe Process of retirement: an attempt at checking Atchley's model of adjustment Penezić, Zvjezdan Lacković-Grgin, Katica Bačinić, Andrijana umirovljenje, Atchleyev model prilagodbe, faze umirovljenja retirement; Atchley's model of retirement; retirement phases Umirovljenje predstavlja normativan životni dogadaj koji zahtijeva prilagodbu osobe pa je opravdano promatrati ga kao proces koji traje odredeno vrijeme. Trajanje i složenost toga procesa ovise o subjektivnim i objektivnim okolnostima zbog kojih umirovljenje može biti redovito ili prijevremeno, prisilno ili dobrovoljno. Na osnovi americkih istraživanja Atchley smatra da se proces umirovljenja može promatrati kao niz prilagodbi predstavljenih u sedam faza: faza kad je umirovljenje još daleko, faza predumirovljenja, faza medenog mjeseca, faza razocaranja, faza reorijentacije, faza stabilnosti i terminalna faza. Te faze nisu slijed dogadaja koje svi prolaze, niti su nužno povezane s nekom kronološkom dobi ili dužinom vremena, kao što je to slucaj s razvojnim fazama tijekom života. Iako su Atchleyeve faze u literaturi široko prihvacene, malo je empirijskih podataka o njihovoj valjanosti, i to samo onih dobivenih na uzorcima americkih umirovljenika. Cilj ovog istraživanja bio je pokušati konstruirati instrument za mjerenje Atchleyevih faza prilagodbe na umirovljenje i provjeriti njegov model na uzorku hrvatskih ispitanika. U ispitivanju je sudjelovalo 196 umirovljenih osoba s podrucja Hrvatske i BiH. U ispitivanju je korišten upitnik koji je sadržavao dio koji se odnosio na opce podatke te listu tvrdnji o procesu umirovljenja Rezultati našeg istraživanja govore u prilog postojanja pet faza iz Atchleyeva modela (faza pripreme, faza medenog mjeseca, faza razocaranja, faza stabilnosti i terminalna faza), ali se deskriptori tih faza ponešto razlikuju od Atchleyeva opisa. Identificirana je još jedna faza koja se u literaturi ne spominje. Nazvali smo je fazom radne reaktivacije (s ciljem pribavljanja sredstava za život, ali bez zasnivanja radnog odnosa). Retirement is a normative life event which requires a person’s adjustment. According to this, retirement should be treated as a process which lasts a certain period of time. The process duration and complexity depend on subjective and objective circumstances in which retirement could be in time or earlier, voluntary or compulsory. According to some American research, Atchley thinks that the retirement process should be treated as a series of adjustments represented through seven phases: the phase when retirement is far away, preretirement phase, honeymoon phase, disappointment phase, reorientation phase, stability phase and terminal phase. These phases are not a sequence of events that everyone goes through, nor are they connected with some chronological age or time of phase, as is the case with lifespan developmental phases. Although Atchley’s phases are accepted in literature there is a small number of empirical data for data validity. Almost all data are collected on the sample of American subjects. The aim of this research was to construct the measurement questionnaire for Atchley’s adjustment to retirement phases, and to check how appropriate his model was for the sample of Croatian subjects. The subjects were 196 retired people in Croatia and Bosnia. The questionnaire consisted partly of the sociodemographic variable measurement, and the list of items related to the retirement process. The results of our research indicated that there were five phases from Atchley’s model (preparation phase, honeymoon phase, disappointment phase, stability phase and terminal phase). But the descriptors of those phases were somewhat different from Atchley’s descriptors. An additional phase, not mentioned in literature, was identified. We called it the working reactivation phase (with the aim of finding funds for life, but without being employed again). General hospital Zadar 2007-06-15 text pdf http://hrcak.srce.hr/12613 http://hrcak.srce.hr/file/19419 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.36 No.3-4; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:12615 2008-06-03 journal:31

Kliničke manifestacije infekcije uzrokovane virusom humane imunodeficijencije (HIV) u otorinolaringologiji Clinical manifestations of infection caused with human immunodeficiency virus (HIV) in otorhinolaryngology Skitarelić, Neven AIDS, HIV, otorinolaringologija, liječenje AIDS; HIV; otorhinolaryngology; therapy Prve informacije o AIDS-u (Acquired immunodeficiency syndrome) pojavile su se u literaturi 1981. godine u SAD. Otada su oboljeli registrirani po cijelom svijetu te se s pravom može govoriti o pandemiji bolesti. Samo u SAD registrirano je oko milijun oboljelih osoba. U osnovi bolesti nastale HIV-om je imunodeficijencija uzrokovana nedostatkom pomocnickih i inducirajucih T-limfocita. Svaki drugi bolesnik s AIDS-om javlja se s nekim od simptoma bolesti lokaliziranim na glavi i vratu. Stoga je poznavanje klinicke slike i tijeka bolesti važno, ne samo radi prepoznavanja novooboljelih i njihove pravodobne dijagnosticke obrade vec i radi što ranijeg pocetka lijecenja te poduzimanja epidemioloških mjera zaštite širenja bolesti. Uz osnovno lijecenje trojnom antivirusnom terapijom, prijeko je potrebno i simptomatsko lijecenje te lijecenje brojnih i cestih komplikacija, koje spadaju u djelokrug rada otorinolaringologa i maksilofacijalnog kirurga. The first information on AIDS (Acquired immunodeficiency syndrome) appeared in USA literature in 1981. Since then, contracted patients of this disease have been registered all over the world, and it can, with good reason, be considered as a pandemic disease. There are approximately one million registered patients in the USA only. The disease that developed through HIV infection is immunodeficiency caused by a deficiency of auxiliary and inducted T lymphocytes. Every second patient with AIDS reports some of the symptoms of the disease localized in the head and neck. Therefore, knowing the clinical picture and development of the disease is important not only for recognizing newly affected patients and their timely diagnostic analysis, but also for beginning with early treatment and undertaking epidemiological protection measures against disease spreading. Basic treatment requires the triple anti virus therapy, while symptomatic treatment and the treatment of numerous and frequent complications that belong in the otorhinolaryngological and maxilofacial surgeon’s sphere of work are also indispensable. General hospital Zadar 2007-06-15 text pdf http://hrcak.srce.hr/12615 http://hrcak.srce.hr/file/19421 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.36 No.3-4; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:16665 2008-06-03 journal:31

Depresija i komorbiditetne bolesti u ambulantama liječnika specijalizanata obiteljske medicine - pilot istraživanje Depression and comorbidity in family medicine registrars' surgeries - pilot research Stojanović-Špehar, Stanislava Skočilić, Ariana Blažeković-Milaković, Sanja Vuković, Hrvoje Kumbrija, Suzana depresija, obiteljska medicina, socioekonomski čimbenici, komorbiditet depression, family medicine, socioeconomic factors, comorbidity Uvod. U primarnoj zdravstvenoj zaštiti nepoznato je 50 % depresivnih poremećeje. Depresija je u 70& slučajeva praćena nekom komorbiditetnom bolešću i razlog je lošijoj prognozi, kao i ishodu te bolesti. Cilj. Istražiti prevalenciju depresije u ambulantama liječnika specijalizanata obiteljske medicine, njezinu povezanost sa socioekonomskim čimbenicima, te utvrditi najčešće komorbiditetne bolesti. Ispitanici i metoda. Istraživanje je provedeno u svibnju 2006., u pet ambulanti liječnika specijalizanata obiteljske medicine iz različitih krajeva Hrvatske - među 7228 pacijenata u njihovoj skrbi. Izdvojeni su pacijenti s dijagnozom depresije prema MKB-10 pod šifrom F 32-Depressio, te šifrom F 33 - Depressio recurrens. Za ovo istraživanje sastavljeni upitnik ispunjen je podacima iz zdravstvenih kartona, te prema procjeni obiteljskih liječnika. Rezultati. Depresija je dijagnosticirana u 179 (2,4%) pacijenata, od kojih je većina -77 (43%) bilo u dobi od 45 do 65 godina, 2,5 puta je češća bila među ženama - 128 (71%). Većina depresivnih pacijenata su bili umirovljenici - 107 (60%). Ispod prosječnog socioekonomskog stanja je bilo 130 (73%) pacijenata. Prema procjeni obiteljskih liječnika 100 (56%) depresivnih pacijenata imalo je dobre obiteljske odnose, te 158 (88%) nije imalo probleme na poslu. "Teškim" pacijentima procijenjeno je 77 (43%) depresivnih pacijenata, a 46 (26%) depresivnih pacijenata nije izgledalo depresivno. Kod 26 % depresivnih pacijenata komorbiditetne bolesti su bile iz dijagnostičke skupine - bolesti mišićnokoštanog sustava (M00-M99), kod 23% bolesti krvožilnog sustava (I00-I99), te kod 15% depresivnih pacijenata bolesti probavnog sustava (K00-K99). Različita je bila raspodjela komorbiditetnih bolesti po dobi i spolu. Zaključak. Prevalencija od samo 2,4 % depresivnih pacijenata je veoma niska i zahtjeva bolju edukaciju specijalizanata obiteljske medicine o depresiji prema preporukama napravljenim u samoj obiteljskoj medicini. Background. 50% of depressive disorders in primary health care are unrecognized. Depression is accompanied by comorbid diseases in 70%, and is the reason for poorer prognosis and poorer comorbidity outcomes. Aim. To investigate the prevalence of depression in family medicine registrars' surgeries, the connection with socioeconomic factors, and to identify the most frequent comorbid diseases. Subjects and Method. Cross-sectional research was provided in May 2006 in five family medicine registrars' surgeries from different parts of Croatia, and among 7228 patients in their care. Patients with diagnosis of depression according to ICD 10, code F32 – Depression and code F33 – Depression recurrences were identified. A questionnaire was constructed for this research and filled with data from medical records and data according to estimations of family physicians. Results. Depression was diagnosed in 179 (2.4%) patients, most of them – 77 (43%) were in the age group from 45 to 65 years of age, 2.5 times more frequent among women – 128 (71%). Most of the depressive patients were among the retired -107 (60%). The socioeconomic status in 130 (73%) depressive patients was estimated as under average. According to family physicians’ estimation 100 (56%) depressive patients had a good family relationship, and 158 (88%) of them had low job strain. 77 (43%) depressive patients were considered as "difficult" patients, and 46 (26%) depressive patients did not look depressed. In 26% of the depressive patients comorbid diseases were from the diagnostic group of diseases of the musculoskeletal system and connective tissue (M00-M99), in 23% diseases of the circulatory system (I00-I99), and in 15% diseases of the digestive system (K00-K99). There was a different distribution of comorbidity among age groups and gender. Conclusion. The prevalence of only 2.4% depressive patients had a very low recognition percentage and implicated better family medicine registrars' education of depression according to recommendations created in family medicine. Key words: depression, family medicine, socioeconomic factors, comorbidity General hospital Zadar 2007-10-16 text pdf http://hrcak.srce.hr/16665 http://hrcak.srce.hr/file/25426 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.37 No.1-2; ISSN 0351-0093 (Print) en

oai:hrcak.srce.hr:16699 2008-06-03 journal:31

Zdravstvena ispravnost i važnost mlijeka i mliječnih proizvoda Health safety and relevance of milk and dairy products Ćurin, Katja Cetinić, Elizabeta mlijeko, mliječni prozvodi, zdravstvena ispravnost namirnica, javno zdravstvo milk, dairy products, food safety, public health Mlijeko i mlijecni proizvodi su namirnice visoke biološke vrijednosti koje u vecim kolicinama i cešce konzumiraju osjetljive populacijske grupe (djeca, trudnice, osobe starije životne dobi). Stoga je pracenje zdravstvene ispravnosti ovih namirnica od posebnog javno-zdravstvenog znacenja. U radu su prikazani rezultati istraživanja zdravstvene ispravnosti mlijeka i mlijecnih proizvoda od 1991. do 2001. godine. U ispitivanom razdoblju zbog mikrobioloških parametara bilo je neispravno 8,2% uzoraka mlijeka i 4,0% uzoraka mlijecnih proizvoda. Zbog kemijskih parametara bilo je zdravstveno neispravno 3,3% uzoraka mlijeka i 6,8% uzoraka mlijecnih proizvoda. Rezultati su praceni kontinuirano u okviru zadanih preporuka, te bi, stoga, taj pozitivni trend trebalo i zadržati. Milk and dairy products are foodstuffs of high biological value consumed frequently and in large quantities by vulnerable groups of population (children, pregnant women, elderly people). Continuous control of these foodstuffs' safety is therefore of particular significance for public health. This paper presents milk and dairy products safety examination results performed in the period from 1991 to 2001. In that period 8.2% of milk samples and 4.0% of dairy product samples were found unsafe on account of microbiological parameters, while 3.3% of milk samples and 6.7% of dairy product samples were found unsafe because of chemical parameters. The results continuously remain within the range of given ecommendations, and that positive trend should be maintained. General hospital Zadar 2007-10-16 text pdf http://hrcak.srce.hr/16699 http://hrcak.srce.hr/file/25556 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.37 No.1-2; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:16702 2008-06-03 journal:31

Q-groznica u Primorsko-goranskoj županiji u razdoblju od 1999.-2005. godine Q-fever in Primorsko-goranska County from 1999 to 2005 Brnčić, Nada Dominović, Marin Q-groznica, Primorsko-goranska županija, 1999.-2005. Q-fever, Primorsko-goranska county, 1999-2005. Q-groznica je jedna od vodecih zoonoza u našoj zemlji koja u pojedinacnim slucajevima najcešce ostaje neprepoznata. U radu je analizirano kretanje Q-groznice tijekom šestogodišnjeg razdoblja od 1999. do 2005. godine u Primorsko-goranskoj županiji. Ukupno je prijavljeno 75 slucajeva Q-groznice, od toga je 58 (77%) muškaraca, najviše u dobnoj skupini od 21-30 godina – 18 (24%). Bolest se najcešce javljala u periodima kasne zime i ranog proljeca Hospitalizirano je svega 15 bolesnika. Smrtnih slucajeva nije bilo. Posebno je obradena epidemija Q-groznice koja je izbila 2004. godine u Novom Vindolskom i njegovoj okolici. Q-fever (Query fever) is one of the leading zoonosis in our country, which, in particular cases, usually remains undetectable. A six-year period in Primorsko-goranska County, from 1999 to 2005, has been analyzed in the study. A total of 75 cases concerning Q-fever have been reported, out of which 58 (77%) involved men, mostly between 21 and 30 years of age – 18 (24%). The disease usually appears in the late winter or early spring. There have been no cases having mortal consequences and only 15 patients have been hospitalized. A special emphasis and research has been given to the Q-fever epidemics that occurred in the year 2004 in Novi Vinodolski and its outskirts. General hospital Zadar 2007-10-16 text pdf http://hrcak.srce.hr/16702 http://hrcak.srce.hr/file/25570 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.37 No.1-2; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:16719 2008-06-03 journal:31

Primarna stečena opstrukcija nazolakrimalnog kanala: epidemiološka analiza 91 bolesnika Primary acquired nasolacrimal duct obstruction: epidemiological analysis of 91 patients Ivanišević, Milan Bojić, Lovro Lešin, Mladen Žuljan, Igor Bućan, Kajo Kovačić, Željko Primarna stečena opstrukcija nazolakrimalnog kanala, epidemiologija Primary acquired nasolacrimal duct obstruction, epidemiology Cilj. Istražiti epidemiološke znacajke primarne stecene opstrukcije nazolakrimalnog kanala (PSONK). Metoda. Ova retrospektivna studija daje pregled hospitaliziranih i ambulantnih bolesnika s PSONK-om tijekom razdoblja od 10 godina, tj. od 1994. do 2003. godine u Splitsko-dalmatinskoj županiji, lijecenih na Klinici za ocne bolesti Klinicke bolnice Split. Ukupan broj bolesnika bio je 91. Rezultat. Godišnja incidencija PSONK-a bila je 1,96 na 100000 stanovnika. Prosjecna dob ± SD bolesnika bila je 64,3 ± 16,0 godina. Bilo je 67 (73,6%) žena i 24 (28,4%) muškaraca. Odnos žena prema muškarcima bio je 2,8, što je statisticki znacajna razlika (p = 0,000007). Razlike u pojavi bolesti izmedu desne i lijeve strane nisu statisticki znacajne (p = 0,64), a bilateralna pojava je primijecena u 6 (6,6%) slucajeva. Akutni oblik PSONK-a javio se u 50 (54,9%) slucajeva, a kronicni oblik u 41 (45,1%) slucaju. Iako je prevalencija akutnog oblika PSONK-a nešto veca u toplijim godišnjim dobima (proljece i ljeto), nego u hladnijim (jesen i zima), sezonske varijacije u pojavi PSONK-a nisu statisticki znacajne (p = 0,26). Zakljucak. Rezultati ove studije su važni jer omogucavaju bolju evaluaciju bolesti i bolje planiranje oftalmološke službe u lijecenju PSONK-a.. Aim. To investigate the epidemiological characteristics of primary acquired nasolacrimal duct obstruction (PANDO). Method. The study was a retrospective view of medical records of inpatients and outpatients who developed PANDO during a 10-year study period from 1994-2003 in Split-Dalmatian County managed at the Eye Clinic of Split University Hospital. The total number of patients was 91. Result. The annual incidence of PANDO was 1.96 per 100,000 inhabitants. The mean age ± SD of patients was 64.3 ± 16.0 years. There were 67 (73.6%) females and 24 (28.4%) males. The female to male ratio was 2.8, the difference was statistically significant (p = 0.000007). The differences in occurence were not statistically significant (p = 0.46) and a bilateral involvement was observed in 6 (6.6%) cases. An acute form of PANDO occured in 50 (54.9%) of cases, and a chronic form in 41 (45.1%) of cases. Although prevalence of an acute form of PANDO was a little greater in warmer seasons (spring and summer) than in colder seasons (autumn and winter), the seasonal variations in the occurrence of PANDO were statistically not significant (p = 0.26). Conclusion. The findings of this study are important because they make possible a better disease evaluation and better ophthalmological service planning in the treatment of PANDO. General hospital Zadar 2007-10-16 text pdf http://hrcak.srce.hr/16719 http://hrcak.srce.hr/file/25663 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.37 No.1-2; ISSN 0351-0093 (Print) en

oai:hrcak.srce.hr:16720 2008-06-03 journal:31

Utjecaj alkohola i droge kod fatalnih utapanja u moru The influence of alcohol and drug consumption in sea drowning fatalities Sutlović, Davorka Definis-Gojanović, Marija alkohol, utapanja, smrt, sudska toksikologija alcohol, drowning, death, forensic toxicology Cilj ove studije je ispitati utjecaj konzumacije alkohola i opojnih droga na sve oblike utapanja u moru u Splitsko-Dalmatinskoj županiji, u periodu od rujna 2001. do kolovoza 2006. godine, a koji su bili obducirani (89) i toksikološki obradeni (62). Kao izvor podataka korišteni su obdukcijski zapisnici i kemijskotoksikološki nalazi Klinickog odjela za sudsku medicinu, Klinicke bolnice Split. Alkohol kao rizican faktor, doprinosio je utapanju, ako je njegova koncentracija bila pozitivna, tj. ako je koncentracija bila veca od 0,5 g/kg. Žrtve utapanja bili su vecinom muškarci srednje životne dobi. Dominantan uzrok smrtnog utapanja bio je nesretan slucaj. U 15 slucajeva koncentracija alkohola u krvi bila je pozitivna. Nijedna žrtva nije bila pod utjecajem lijekova, droga niti drugih sredstava ovisnosti. Iz navedenog se može zakljuciti da nijedna žrtava utapanja u Splitsko-Dalmatinskoj županiji, u ispitivanom periodu, nije bila pod utjecajem droga. Kod malog broja žrtava koncentracija alkohola bila je pozitivna, a u navedenim smrtnim slucajevima imala je malu ulogu. The aim of the study is to investigate the influence of alcohol and drug consumption in all types of sea drowning lethal cases occurred in Split-Dalmatian County from September 2001 to August 2006, autopsied (89) and toxicologicaly analyzed (62). The autopsy reports of the Department of Forensic Medicine, Split University Hospital and School of Medicine were reviewed. Alcohol was regarded as a contributive death factor if the blood concentration was positive (BAC > 0.5 g/kg). Most of the victims were middle-aged to elderly males. The predominating cause of drowning fatalities was by accident. In 15 cases the concentration of alcohol in blood was positive. No victims were intoxicated by any kind of drug at the time of their death. It can be concluded from the above said that the majority of drowning deaths in Split-Dalmatian County were not drug related. Alcohol, which was the only type of drug detected, plays a minor role in such deaths. General hospital Zadar 2007-10-16 text pdf http://hrcak.srce.hr/16720 http://hrcak.srce.hr/file/25665 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.37 No.1-2; ISSN 0351-0093 (Print) en

oai:hrcak.srce.hr:16769 2008-06-03 journal:31

Sociodemografske karakteristike ovisnika o alkoholu liječenih na Psihijatrijskom odjelu Opće bolnice u Dubrovniku tijekom 1992., 2000. i 2005. godine Sociodemographic characteristics of alcohol addicts hospitalized at the Department of Psychiatry of Dubrovnik General Hospital during 1992, 2000 and 2005. Ljubičić, Đulijano Ljuban, Slavica Ovisnost o alkoholu, hospitalizacija, sociodemografske karakteristike Alcohol addiction, hospitalization, sociodemographic characteristics Cilj ovoga rada je prikazati sociodemografske karakteristike ovisnika o alkoholu lijecenih na Psihijatrijskom odjelu Opce bolnice Dubrovnik. Istraživanjem su obuhvaceni svi alkoholni ovisnici, a lijeceni tijekom 1992., 2000. i 2005. god. Podaci su prikupljeni iz bolnickog registra i povijesti bolesti, a obuhvaceni su sljedeci parametri: spol, dob, bracno stanje, školska sprema i radni status. Rezultati ukazuju da bolesnici lijeceni zbog ovisnosti o alkoholu još uvijek zauzimaju veliki dio psihijatrijskih kreveta, iako se kroz godine vidi tendencija smanjenja hospitalizacija. Takoder je vidljivo da je veci broj muških pacijenata. Vecinom su to osobe srednje životne dobi, a i kod žena i kod muškaraca radi se prvenstveno o oženjenim i zaposlenim ljudima. Dobivenim podacima dobiva se uvid u sociodemografske karakteristike lijecenih ovisnika o alkoholu na podrucju Dubrovacko-neretvanske županije s ciljem planiranja što kvalitetnije psihijatrijske skrbi ovih bolesnika. The purpose of this research was to examine the sociodemographic characteristics of alcohol addicts treated at the Department of Psychiatry of Dubrovnik General Hospital. All patients hospitalized because of alcohol addiction at the Department of Psychiatry of Dubrovnik General Hospital during 1992, 2000 and 2005 were included in this research. Data used in order to perform this research was gathered from hospital records and patients' case histories. Criteria assessed were: gender, age, marital status, employment and level of education. Results show that alcohol addicts still account for a great deal of psychiatric hospitalizations, although there is a noticeable tendency of decreasing the number of alcohol related hospitalizations. Furthermore, the majority of patients hospitalized because of alcohol addiction are male. Patients hospitalized are mostly middle-aged, married and employed. Acquired research data gives us a valuable insight into the sociodemographic characteristics of alcohol addicts in Dubrovacko-neretvanska County and enables further planning of quality psychiatric care of alcohol addicts. General hospital Zadar 2007-10-16 text pdf http://hrcak.srce.hr/16769 http://hrcak.srce.hr/file/25841 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.37 No.1-2; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:16770 2008-06-03 journal:31

Teško je naći dobra čovjeka Jamnicki Dojmi, Mirko General hospital Zadar 2007-10-16 text pdf http://hrcak.srce.hr/16770 http://hrcak.srce.hr/file/25843 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.37 No.1-2; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:19107 2008-06-03 journal:31

Identifikacija, opis i analiza uzroka nekih negativnih ponašanja u radnom okružju medicinskih sestara Identification, description and analysis of some negative behavior causes in the nurse work environment Krajnović, Franka Šimić, Nataša Franković, Sanda Negativna ponašanja, medicinske sestre, stres, mobing. Negative behavior, nurses, stress, mobbing. U ispitivanju su sudjelovale 1354 medicinske sestre i tehnicara. Skoro polovina ispitanika se požalila na doživljena negativna iskustva, a najviše se ispitanika požalilo kolegama s posla i clanovima obitelji. Prema percepciji ispitanih medicinskih sestara i tehnicara, najucestaliji oblici ponašanja u njihovom radnom okružju su: omalovažavanja, vikanja, vrijedanja, ignoriranje mišljenja i stavova, privilegiranja pojedinih clanova tima unutar raspodjele poslova, komentiranje privatnog života, te neosiguravanje zamjene za odsutne djelatnike i negativan odnos prema njihovom radu. Dobiveni rezultati takoder ukazuju da negativna ponašanja proizilaze iz stresnih uvjeta rada i organizacijskih problema, kao i manjkavih komunikacijskih vještina. The aim of this study was to examine an incidence of negative behaviour, the reasons of its existence, as well as some responses on investigated behaviours. 1354 nurses and medical assistants took part in the study. Half of the subjects complained on negative experiences, while most subjects complained of work colleagues and family members. The results of the research imply that the most frequent forms of behaviour in nurses and medical assistants are: disparage, yelling, insulting, ignoring of one’s opinion and attitudes, making some team members privileged, commenting of one’s personal life, not securing a replacement for the absent workers and a negative attitude towards their work. The results of the study also show that negative behaviour results in stressful work conditions and organizational problems, as well as lack of communication skills. General hospital Zadar 2008-01-10 text pdf http://hrcak.srce.hr/19107 http://hrcak.srce.hr/file/29847 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.37 No.3-4; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:19108 2008-06-03 journal:31

Nove spoznaje o imunogenetici psorijaze Immunopathogenetic mechanisms in psoriasis Kaštelan, Marija Prpić- Massari, Larisa Psorijaza, geni HLA, imunogenetika, limfociti T Psoriasis, HLA genes, immunogenetics, T-lymphocytes Psorijaza je kronicna bolest kože obilježena ubrzanom proliferacijom epidermisa koja se klinicki manifestira pojavom upalnih, oštro ogranicenih ploca razlicite velicine, prekrivenih srebrno-bijelim ljuskama. Pretpostavlja se da je uzrokovana imunološkom reakcijom na do sada još nedovoljno definiran epidermalni, dermalni ili cirkulirajuci imunogeni peptid (M-protein streptokoka, retrovirusni protein ili antigen rožnatog sloja epidermisa). Na temelju brojnih istraživanja zakljuceno je da geni sustava HLA imaju kljucnu ulogu u nasljedivanju psorijaze. Imunopatogenetski mehanizmi razvoja psorijaze još uvijek nisu u cijelosti rasvijetljeni. Smatra se da nazocnost pojedinih gena HLA podložnih za psorijazu može potaknuti nastanak izuzetno jake imunološke reakcije na odredeni antigenski peptid, što u konacnici za posljedicu ima razvoj bolesti. Jedan od mogucih mehanizama nastanka psorijaze je aktivacija velikog broja T-limfocita streptokoknim superantigenom. Druga mogucnost za razvoj autoagresije je model molekularne mimikrije. Iako nije poznato na koji nacin zapocinje psorijaticni proces, danas se pretpostavlja da je psorijaza genetski poremecaj proliferacije keratinocita posredovan limfocitima T. Proces nastanka psorijaticnog žarišta izrazito je dinamican, a ukljucuje interakciju pomagackih i citotoksicnih limfocita T, te limfocita T i keratinocita. Razumijevanje imunopatogenetskih mehanizama u nastanku sorijaze omoguciti ce i razvoj ciljane terapije ove teške kronicne bolesti. Psoriasis is a chronic skin disease characterized by epidermal hyperproliferation and clinically by inflammatory, well sharped erythematosquamous plaques. It seems that psoriasis is mediated by an immunologic reaction to particular epidermal, dermal or circulating immunogenic peptide (streptococcal M protein, retroviral protein or some epidermal antigen). Population based studies revealed that HLA genes have a key role in psoriasis inheritance. The immunopathogenetic mechanisms in psoriasis development are not yet completely elucidated. It seems that the presence of particular HLA genes susceptible for psoriasis could stimulate extremely strong immunological reaction to some antigenic peptides resulting in the development of the disease. Possible mechanism in psoriasis development is the activation of numerous Tlymphocytes by streptococcal superantigen. Another possibility is the model of molecular mimicry. Although the precise mechanism of activated T cells trigger psoriasis is as yet unknown, it seems that psoriasis is a genetic disorder of keratinocyte hyperproliferation mediated by T-lymphocytes. The psoriatic process is a dynamic one that includes interaction between helper and cytotoxic T-lymphocytes, as well as between T cells and keratinocytes. A better understanding of the psoriasis immunopathogenesis would enable development of specific T cell targeted therapies for this severe chronic disease. General hospital Zadar 2008-01-10 text pdf http://hrcak.srce.hr/19108 http://hrcak.srce.hr/file/29849 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.37 No.3-4; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:19181 2008-06-03 journal:31

Retrospektivni prikaz kirurškog liječenja primarnog karcinoma pluća u Općoj bolnici Zadar u razdoblju od 2000.-2005. A retrospective report on primary lung cancer surgery treatment in Zadar General Hospital in the period from year 2000 to 2005 Bačić, Ivan Bubičić, Josip Medić, Marko Morović, Domagoj Primarni karcinom pluća, kirurško liječenje, torakalna kirurgija. Primary lung cancer, surgery treatment, thoracic surgery Ovo je retrospektivni prikaz kirurškog lijecenja pacijenata koji boluju od primarnog karcinoma pluca, cija bolest ispunjava kriterije indikacije za kirurško lijecenje. Kriteriji za kirurško lijecenje odnose se na stadij bolesti (TNM klasifikacija), te na fiziološke parametre pacijenta (komorbiditet, spirometrijeske vrijednosti). Prikazali smo 146 pacijenata, od toga 118 muškaraca i 28 žena prosjecne životne dobi 53,5 godina (23-84). Pacijente smo podijelili prema stadiju bolesti i prema vrsti operacijskog zahvata kojem su bili odvrgnuti.Rezultati kirurškog lijecenja primarnog karcinoma pluca u našoj ustanovi ne odstupaju od istih navedenih u recentnoj svjetskoj literaturi. Osim toga , naši rezultati pokazuju veliki broj pacijenata s uznapredovalom bolešcu kod kojih osim operacijskog lijecenja treba primijeniti i adjuvantnu kemo i radioterapiju. This is a retrospective report on the surgery treatment of patients suffering from primary lung cancer whose disease fulfills the criteria for surgical treatment. Surgery treatment criteria refer to the disease (TNM classification) and the physiological parameters of the patients comorbidity, spirometric values). We showed 146 patients, of which 118 male and 28 female of 53.5 average age (23-84). We divided the patients according to the disease stage and the type of surgery performed. The results of primary lung disease treatment in our institute adhere to the ones mentioned in recent world literature. Moreover, our results show a great number of patients with an advanced disease, where, besides surgery treatment, additional chemo and radiotherapy have to be applied. General hospital Zadar 2008-01-10 text pdf http://hrcak.srce.hr/19181 http://hrcak.srce.hr/file/29968 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.37 No.3-4; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:19182 2008-06-03 journal:31

Rano otkrivanje dijabetesa melitusa u obiteljskoj medicini Early detection of diabetes mellitus in family medicine Vrca-Botica, Marija Katić, Milica Katić-Milošević, Ivana Dijabetes melitus, obiteljski liječnik, probiranje-skrining Diabetes melitus, family practitioner, screening Incidencija dijabetesa melitusa danas zauzima epidemijske razmjere. 90-95% bolesnika cine pacijenti s Tipom 2 dijabetesa. Bolest se sporo razvija, i ima dugu asimptomatsku fazu. Klinicki se otkrije nakon 5-10 godina trajanja. Bolesnik s dijabetesom, zbog komplikacija bolesti, umire ranije od svojih vršnjaka bez dijabetesa. Poznati su pozitivni ucinci ranog otkrivanja bolesti – probiranjem (skriningom). Još nisu nadeni idealni modeli provodenja probiranja za rano otkrivanje bolesti, za otkrivanje stadija povecane glukoze natašte i stadija oštecene tolerancije glukoze. Nisu dobiveni efinitivni odgovori ni na pitanja: tko ce provoditi skrining, gdje ce se provoditi i kako? Kako odrediti rizicne skupine? Kako provoditi probiranje u tranzicijskoj obiteljskoj medicini? Znanost i struka se u jednome slažu: obiteljski lijecnik ima kljucnu ulogu u ranom otkrivanju bolesti. The incidence of diabetes mellitus today precedes epidemic dimensions. 90-95% of diabetic patients have type 2 diabetes. The disease develops slowly, and it has a long asymptomatic phase. Clinical detection comes after 5-10 years of disease duration. Due to disease complications, diabetic patients die earlier than their peers without diabetes. Positive effects of early disease detection (screening) are well known. The perfect models of screening for early diseases detection high level fasting glucose stage and the impaired glucose tolerance stage detection haven’t been found yet. Definitive answers to the following questions haven’t also been found yet – Who will conduct the screening, where and how? How to determine the risk groups? How to conduct the screening in transitional family medicine? Science and profession concur in one thing: the family practitioner has the key role in early disease etection. General hospital Zadar 2008-01-10 text pdf http://hrcak.srce.hr/19182 http://hrcak.srce.hr/file/29970 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.37 No.3-4; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:19213 2008-06-03 journal:31

Tumorozni oblik plućne tuberkuloze u djeteta: prikaz slučaja Tumorous form of lung tuberculosis in children: case report Raos, Miljenko Batinica, Stipe Marković, Jelica Verona, Eva Tuberkuloza, pluća, dijete Tuberculosis, lung, children U radu je prikazan djecak u dobi od dvije godine i osam mjeseci s tumoroznim oblikom plucne tuberkuloze. Na temelju rendgena pluca, te racunalne tomografije toraksa (CT), postavljena je dijagnoza ekspanzivne tvorbe u podrucju desnog gornjeg sredoprsja. Izvršena je lobektomija desnog gornjeg plucnog režnja, a patohistološki nalaz glasio je: granulomatozna upala, u prvom redu tuberkuloza. Kod tumoroznih tvorbi u podrucju sredoprsja, diferencijalno dijagnosticki uvijek treba misliti i na tuberkulozu, posebice kada se nade i središnja nekroza. A 2 year and 8 month-old boy with a tumorous form of lung tuberculosis is presented. Both, chest X-ray and thoracic CT, respectively showed an expansive formation in the right upper mediastinum. Right upper lung lobe lobectomy was performed, and granulomatous inflammation (tuberculosis) was confirmed pathohystologically. In the case of mediastinal tumorous formation (especially accompanied with central necrosis), tuberculosis has to be considered in differential diagnostics. General hospital Zadar 2008-01-10 text pdf http://hrcak.srce.hr/19213 http://hrcak.srce.hr/file/30028 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.37 No.3-4; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:22671 2008-06-03 journal:31

Učestalost nalaza najčešćih bakterijskih uzročnika infekcije mokraćnog sustava u djece i njihova osjetljivost na antimikrobne lijekove The frequency of most common organisms causing urinary tract infection in pediatric patients and their susceptibility to antimicrobial drugs Prohaska-Potočnik, Carmen; Institute of Microbiology, Parasitology and Hospital Infections, Clinic Hospital "Sestre milosrdnice", Zagreb Vukadinović, Marija Vesna; Institute of Microbiology, Parasitology and Hospital Infections, Clinic Hospital "Sestre milosrdnice", Zagreb Car, Haris; Institute of Microbiology, Parasitology and Hospital Infections, Clinic Hospital "Sestre milosrdnice", Zagreb Infekcije mokraćnog sustava (IMS); djeca; antibiotici; otpornost; Escherichia coli. Urinary tract infection (UTI), children, Antibiotic resistance, Escherichia coli. Infekcije mokracnog sustava (IMS) ceste su u djece, po ucestalosti odmah iza infekcija dišnih putova. U male djece su pokazatelj abnormalnosti mokracnog sustava, a u novorodencadi mogu biti izvor bakterijemije/sepse. Ako se pravovremeno ne otkriju i ne lijece, mogu dovesti do trajnog oštecenja bubrega i hipertenzije. Svrha ovog istraživanja bila je utvrditi ucestalost najcešcih uzrocnika IMS-a u uzorcima mokrace pacijenata Klinike za pedijatriju, te osjetljivost/otpornost tih uzrocnika na najcešce upotrebljavane antimikrobne lijekove u toj populaciji. Za urinokulture zasijano je, pomocu kalibrirane pipete, po 0,01 ml nerazrijedene mokrace na standardne cvrste hranjive podloge. Obradeno je 550 uzoraka. Iz urinokultura sa znacajnim brojem bakterija najcešce je izdvojena Ecshcerichia coli (71%), zatim Proteus mirabilis (11%), Klebsiella pneumoniae (7%), Enterococcus (7%), Pseudomonas (2%) i Morganella morganii (2%). Proteus je cešce naden u djecaka (9/15), a klebsijela u djevojcica (7/9). Od izdvojenih sojeva E. coli, 70% je otporno prema ampicilinu, a 30% prema kotrimoksazolu, pa ti lijekovi nisu prikladni za empirijsku profilaksu, ni za lijecenje. Najdjelotvorniji su cefalosporini II.i III. generacije. U pretraženom uzorku bilo je 13% ESBL-pozitivnih sojeva E. coli, 9/12 u djecaka, 6/9 u prvom mjesecu života. Preporuca se stalno pracenje spektra osjetljivosti/otpornosti u najcešce izdvojenih uzrocnika IMS-a u djece, radi procjene odabira pravog lijeka za empirijsku primjenu. After respiratory infections, urinary tract infections (UTI) are most common in pediatric patients. In young children, UTI is a marker for urinary tract abnormalities and in the newborn it may be associated with bacteraemia. In infants/early school age children it may lead to renal scarring, hypertension and rarely to the end stage renal failure. The aim of the present study was to identify the most common bacteria, causative agents of UTI in urine of pediatric patients, as well as their susceptibility to antimicrobial drugs commonly used for UTI prevention and treatment in children. Urine cultures were seeded (inoculated), 0,01 ml of undiluted urine samples, with calibrated pipette on standard nutrient media. In urine cultures with signifficant bacterial count, Escherichia coli was the most common organism isolated (71%), followed by Proteus mirabilis (11%), Klebsiella pneumoniae (7%), Enterococcus (7%), Pseudomonas (2%) and Morganella morganii (2%). Proteus is more often found in boys (9/15) and Klebsiella in girls (7/9) .Resistance against ampicillin in isolated E. coli strains were 70% against otrimoxasol 30% . Their use in empirical treatment is inadequate. In the investigated samples 13% ESBL-positive strains of E. coli were found, 9/12 in boys, 6/9 during the first month of life. To evaluate the options for empirical treatment, permanent follow up of sensitivity/resistance pattern in the most commonly isolated causative agents of UTI in pediatric patients is recommended. General hospital Zadar 2008-05-05 text pdf http://hrcak.srce.hr/22671 http://hrcak.srce.hr/file/35690 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.38 No.1-2; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:22680 2008-06-03 journal:31

Metabolički sindrom u dijabetičara tipa 2 Metabolic syndrome in type 2 diabetics Kuzmanić, Marion; Split University Faculty of Medicine, Family Medicine Program; mkuzmani1@bsb.mefst.hr Vrdoljak, Davorka; Split University Faculty of Medicine, Family Medicine Program Rumboldt, Mirjana; Family Medicine Surgery, Sućidar 79/II, 21 000 Split Petric, Dragomir; Splitsko-dalmatinska County Community Health Care, Family Medicine Surgery, Trg hrvatske bratske zajednice 7, 21000 Split Dijabetičari tipa 2; metabolički sindrom; obiteljska medicina. Metabolic syndrome; type 2 diabetics; family medicine. Cilj. Utvrditi ucestalost metabolickog sindroma (MS) u dijabeticara tipa 2 i razlike u njegovoj prevalenciji po kriterijima Svjetske zdravstvene organizacije (SZO) i Americkog nacionalnog programa edukacije o kolesterolu (NCEP-ATP III). Ispitanici i metode. Ukljuceni su svi dijabeticari tipa 2 stari 18 godina, u skrbi cetiri obiteljska lijecnika (LOM) koji medicinsku dokumentaciju vode elektronskim putem. Prireden je anketni upitnik s pitanjima o sociodemografskim podacima, životnim navikama, komorbiditetu, trajnoj medikamentnoj terapiji, antropometrijskim mjerenjima i cimbenicima kardiovaskularnog rizika. Svi podaci, osim antropometrijskih mjerenja (visina, težina, opseg struka), prikupljeni su retrospektivno. Rezultati. Analizirana su 243 dijabeticara tipa 2, što cini 3,79% od 6400 osiguranika u skrbi. Od toga je bilo 120 (49,4%) žena i 123 (50,6%) muškarca, prosjecne dobi 66,68 ± 9,23 godine. Prema definiciji SZO metabolicki sindrom ima 62 (25,2%), a po kriterijima NCEP-ATP III 117 (48,1%), ispitanika što je statisticki znacajna razlika (2 = 31,80; P < 0,001). MS je bio znacajno cešci u skupini ispitanika koji prekomjerno piju (2 = 13,56; P = 0,001), kao i tjelesno neaktivnih dijabeticara (2 = 10,52; P = 0,005). Zakljucak. Rezultati ovog istraživanja pokazuju relevantno vecu ucestalost MS-a u dijabeticara tipa 2 po kriterijima NCEP-ATP III, nego po kriteriju SZO o cemu treba voditi racuna pri usporedivanju razlicitih podataka. Mjerenje opsega struka trebalo bi implementirati u svakodnevni rad LOM-a. Temelj lijecenja MS su nefarmakološke mjere (gubitak težine i tjelovježba). Specificni odnos lijecnik – bolesnik omogucuje utjecaj na mijenjanje navika i ponašanja bolesnika. Zbog slabe percepcije odgodenog rizika to je najteže provediva, a najucinkovitija mjera lijecenja MS-a. Aim. The aim of this study was to determine the frequency of the metabolic syndrome (MS) in type 2 diabetics and to investigate the possible difference in frequency, calculated according to the World Health Organisation (WHO) and The Third Report of The National Cholesterol Education Program Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (NCEP-ATP III) criteria. Subjects and methods. Enrolled were all type 2 diabetics aged 18, enlisted in four computorised family physician's offices. The questionnaire created for the purpose of this study included sociodemographic and anthropometric data, data on life habits, comorbidity, medication and cardiovascular risk factors. Data were collected from medical records retrospectively, while anthropometric data on body height, weight and waist measurement were collected by additional measurements. Results. Data on 243 type 2 diabetics were collected (3.79% of 6440 patients enlisted), 120 (46.4%) female and 123 (50.6%) male. The average age was 66.68 ± 9.23. According to WHO criteria 62 (25.2%) examinees in our sample met the metabolic syndrome criteria, while according to NCEP-ATP III criteria that number was significantly higher 117 (48.1%), ( = 31.8, P < 0.001). In our sample MS occurred more often in heavy alcohol drinkers ( = 13.56, P = 0.001) and in diabetics who lacked regular physical activity ( = 10.52, P = 0.005). Conclusion. There are several MS definitions, those by WHO and NCEP-ATP III are the most often used. In this study a markedly higher prevalence of the metabolic syndrome among type 2 diabetics was observed when assessed according to NCEP-ATP III criteria, which must be kept in mind while comparing different data. Taking waist measurements is an easy and sensitive method of detecting MS and should be implemented in the family physician's daily practice. Nonpharmacological measures (weight loss and exercise) are fundamental for MS treatment. The family physician has an unique opportunity to influence MS patients' lifestyle modifications, which is the most effective and the most difficult measure to carry out because of the patients' inadequate perception of delayed risk. General hospital Zadar 2008-05-05 text pdf http://hrcak.srce.hr/22680 http://hrcak.srce.hr/file/35702 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.38 No.1-2; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:22681 2008-06-03 journal:31

Značaj IgG aviditeta u dijagnostici infekcije citomegalovirusom u trudnica i novorođenčadi Value of IgG avidity in cytomegalovirus infection diagnosis in pregnant women and newborn infants Vilibić-Čavlek, Tatjana; Public Health Care Institute, Virology Department Ljubin-Sternak, Sunčanica; Public Health Care Institute, Virology Department Mlinarić-Galinović, Gordana; Public Health Care Institute, Virology Department CMV, IgG aviditet, trudnice, novorođenčad. CMV, IgG avidity, pregnancy, newborn. Cilj rada: Ispitati vrijednost IgG aviditeta u dijagnostici CMV infekcije u trudnica i novorodencadi. Metode: Tijekom trogodišnjeg perioda (2003-2005) prikupljeni su uzorci seruma od 64 trudnice, te 32 djece do godinu dana starosti sa suspektnom kongenitalnom/perinatalnom CMV infekcijom. Serumi su testirani na prisustvo CMV IgM i IgG protutijela metodom ELISA, te aviditet IgG protutijela uz primjenu uree. Rezultati: U skupini trudnica s pozitivnim IgM protutijelima, u njih 2/26 (7,6%) dokazan je porast indeksa IgG aviditeta (AI), od granicnog u visoki AI u parnim uzorcima seruma, što ukazuje na nedavnu primarnu CMV infekciju, dok je 24/26 (92,4%) imalo visok AI (prošla CMV infekcija). Sve trudnice s negativnim IgM protutijelima imale su visok AI. U djece mlade od 12 mjeseci, akutna/nedavna primarna CMV infekcija dokazana je u 8/12 (66,7%) djece s pozitivnim IgM, te u 10/20 (50,0%) djece s negativnim IgM protutijelima. U dvoje djece mlade od 3 mjeseca s visokim AI, CMV infekcija je potvrdena izolacijom virusa iz urina. U jednog od njih došlo je do pada AI iz visokog u niski, u parnom uzorku seruma. Zakljucci: Pomocu testa IgG aviditeta moguce je razluciti primarnu od prošle CMV infekcije u trudnica i djece starije od 3 mjeseca. U djece mlade od 3 mjeseca, transplacentarno prenesena majcina IgG protutijela visokog aviditeta mogu utjecati na rezultate seroloških pretraga. Aim: To asses the value of IgG avidity in diagnosis of CMV infection in pregnant women and newborn infants. Methods: During the three-year period (2003-2005) serum samples from 64 pregnant women and 32 infants less than 12 months of age with suspected congenital/perinatal CMV infection were collected. Sera were tested for CMV IgM and IgG using an indirect enzyme-linked immunosorbent assay and IgG avidity using urea as denaturing agent. Results: Among IgM positive women, 2/26 (7.6%) showed an increase of IgG avidity index (AI) from intermediate to high AI in paired sera samples indicating recent primary infection and 24/26 (92.4%) showed high AI indicating past infection. All women with negative IgM antibodies had high AI. In infants less than 12 months old, acute/recent primary CMV infection was documented in 8/12 (66.7%) children with positive IgM and in 10/20 (50.0%) children with negative IgM antibodies. In two children less than three months with high AI, CMV infection was confirmed by virus isolation from urine. One of them showed a decrease of AI from high to low in paired sera samples. Conclusions: IgG avidity differentiates primary from nonprimary CMV infection in both pregnant women and infants older than three months. In children less than 3 months of age, transplacentally transferred maternal antibodies of high avidity may influence on the serologic test results. General hospital Zadar 2008-05-05 text pdf http://hrcak.srce.hr/22681 http://hrcak.srce.hr/file/35705 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.38 No.1-2; ISSN 0351-0093 (Print) en

oai:hrcak.srce.hr:22772 2008-06-03 journal:31

Pneumokokno povezani hemolitsko-uremički sindrom nakon invazivne pneumokokne bolesti kod dvogodišnje djevojčice Pneumococcal associated haemolytic uremic syndrome following invasive pneumococcal disease in a 2-year-old girl Čulić, Srđana; Split Clinical Hospital Center, Pediatrics Department, Pediatric Haematology, Oncology and Medicine Genetics Department; srdjana.culic@st.htnet.hr Kuljiš, Dubravka; Split Clinic Hospital Center, Pediatrics Department, Pediatric Haematology, Oncology and Medicine Genetics Department Čulić, Vida; Split Clinic Hospital Center, Pediatrics Department, Pediatric Haematology, Oncology and Medicine Genetics Department Hemolitičko-uremički sindrom; invazivna pneumokokna bolest; dijete. Haemolytic uremic syndrome; invasive pneumococcal disease; child. Hemoliticko-uremicki sindrom karakterizira mikroangiopatska hemoliticka anemija, trombocitopenija i akutno zatajenje bubrega. Najcešce se javlja u djece u dobi mladoj od 4 godine. Etiologija je povezana s nekim infektološkim agensima kao što je Streptococcus pneumoniae. Prikazali smo slucaj dvogodišnje djevojcice s invazivnom pneumokoknom bolesti s hemoliticko-uremickim sindromom. Bolest je pocela infekcijom gornjeg respiratornog trakta. Djevojcica je primljena u vrlo teškom stanju, ekstremno blijeda, adinamicna, konfuzna, dispnoicna, dehidrirana u kolapsu periferne cirkulacije. Obostrano nad plucima culi su se brojni bronhiticki hropci, a jetra i slezena su bile uvecane. Klinicki i laboratorijski potvrdili smo da je u djevojcice pneumokokna invazivna bolest (pleuropneumonija, sepsa i septicki šok) uzrokovana Streptokokom pneumonije potaknula nastanak hemoliticko-uremickog sindroma. Uspješno izljecenje postignuto je primjenom visokih doza kortikosteroida, svježe smrznute plazme, antibiotika i intravenoznih imunoglobulina. The haemolytic uremic syndrome is characterized by microangiopathic haemolytic anaemia, thrombocytopenia and acute renal failure and is the most common in children under the age of 4. The etiology can be associated with some infectious agents like Streptococcus pneumoniae. We review the case of a 2-year-old girl presenting with invasive pneumococcal disease followed by the haemolytic uremic syndrome. The onset of the haemolytic uremic syndrome clinical manifestation was preceded by un upper respiratory tract infection. The physical finding was in extremely bad condition with pallor. She was adinamic, confused, dispnoic, dehydrated with peripheral circulatory failure. Tubular breath sounds with moist rales on both sides of the lung were registered as well as liver and spleen enlargement. Presenting clinical and laboratory data we confirmed that, in our case, following the invasive pneumococcal disease (pleuropneumonia, sepsis and septic shock), Streptococcus pneumoniae was the trigger of HUS. High doses of corticosteroids, fresh frozen plasma, antibiotics, and intravenous immunoglobulins were a successful treatment. General hospital Zadar 2008-05-05 text pdf http://hrcak.srce.hr/22772 http://hrcak.srce.hr/file/35858 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.38 No.1-2; ISSN 0351-0093 (Print) en

oai:hrcak.srce.hr:22774 2008-06-03 journal:31

Broj hospitalizacija poradi demencija i organskog psihosindroma na Psihijatrijskom odjelu Opće bolnice u Zadru kroz 20 godina Number of hospitalization due to dementias and organic psychosyndrome at Zadar General Hospital Psychiatric Ward in the last 20 years Gilić, Ante; Zadar General Hospital, Psychiatry Department; ante.gilic@zd.t-com.hr Perinčić, Robert; Zadar General Hospital, Psychiatric Department Kovač, Ilona; Zadar General Hospital, Psychiatric Department Hospitalizacija; Alzheimer; demencije. Hospitalization; Alzheimer; dementia. Po Izvješcu Svjetske zdravstvene organizacije o stanju duševnog zdravlja u svijetu iz 2001. godine, AB i ostale demencije imaju prevalenciju od 0,6% u opcoj populaciji. Zadarska županija ima 165.000 stanovnika i predvidivo je da po toj stopi ima oko 1000 pacijenata s AB i ostalim demencijama. Pratili smo kretanje hospitalizacija poradi AB, ostalih demencija i organskog psihosindroma na Psihijatrijskom odjelu Opce bolnice Zadar kroz 20 godina i podijelili to razdoblje u dva dijela: od 1986. do 1995. godine (5 godina prije rata i 5 godina rata), te od 1996. do 2005. (deset godina poslije rata). Našli smo da je broj hospitalizacija poradi AB, ostalih demencija i organskog psihosindroma, kroz razdoblje 1986-1995. godine bio: Alzheimerova bolest – 2, ostale demencije – 40, organski psihosindrom – 89, dakle ukupno 131, dok je ukupan broj hospitalizacija na psihijatrijskom odjelu u Zadru bio je 4439. Kroz razdoblje 1996.- 2005. godine broj hospitalizacija poradi istih poremecaja bio je: Alzheimerova bolest – 54, ostale demencije – 156, organski psihosindrom -138, dakle ukupno 348 od ukupno 6071 hospitalizacija. Znaci, u prvom promatranom razdoblju 2,64% od ukupno hospitaliziranih pacijenata hospitalizirano je poradi AB, ostalih demencija i organskog psihosindroma, a u razdoblju 1996.-2005. godine 5,73% od ukupno hospitaliziranih pacijenata hospitalizirano je poradi M. Alzheimer, ostalih demencija ili organskog psihosindroma. Izracunom smo pokazali da je ta razlika i statisticki znacajna. Te razlike možemo tumaciti na razne nacine – porastom broja demencija i organskog psihosindroma i povecanjem broja hospitalizacija ili pak smanjenjem tolerancije obitelji spram oboljelih od tih poremecaja i težnjom hospitalizaciji. U svakom slucaju društvo i psihijatrijska djelatnost nalaze se pred problemom pojacanog pritiska za hospitalizacijom pacijenata s demencijom ili organskim psihosindromom, i kao društvo moramo poduzeti adekvatne mjere u rješavanju tog sve prisutnijeg problema. According to the World Health Organization report on the state of mental health published in 2001, the prevalence of AD and other dementias was 0.6% in the general population. Zadar county has 165.000 inhabitants, so, using this percentage, we can predict there are some 1000 patients with AD and dementia in our county. We have investigated the rate of hospitalization of patients with AD, other dementias and organic psychosyndrome in Zadar General Hospital Psychiatric Ward in the last 20 years. We divided this period into two parts – 1986 to 1995 (5 years before the war and 5 years of war) and 1996-2005 (ten years after the war). We found that the number of hospitalized patients with AD, other dementias and organic psychosyndrome in 1986-1995 was: Alzheimer's disease – 2, other dementias – 40, organic psychosyndrome – 89, total – 131, and the total number of hospitalized patients was 4439. In the period of 1996-2005 the number of hospitalized patients with the same disorders was: Alzheimer`s disease – 54, other dementias – 156, organic psychosyndrome – 138, total – 348, and the total number of hospitalized patients was 6071. We can see that in the first monitored period 2.64% of hospitalized patients had AD, other dementias and organic psychosyndrome, and in the second period 5.73% of the hospitalized patients had these disorders. The difference is statistically significant. This difference can be interpreted in different ways – growth in the number of dementias and organic psychosyndrome patients and the increased number of hospitalizations or the decrease of family tolerance towards such patients and the wish for hospitalization. In any case, society and psychiatric professionals are confronting a problem of increased pressure in hospitalizing patients with dementia or organic psychosyndrome, and as a society we have to take adequate measures in solving this emerging problem. General hospital Zadar 2008-05-05 text pdf http://hrcak.srce.hr/22774 http://hrcak.srce.hr/file/35860 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.38 No.1-2; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:22835 2008-06-03 journal:31

Neuroendokrini karcinom stražnjeg medijastinuma - Prikaz slučaja Neuroendocrine carcinoma of the posterior mediastinum - a case report Krvavica, Ana; Zadar General Hospital, Pathology and Forensic Medicine Department; ana.krvavica@zd.htnet.hr Neuroendokrini karcinom; tumori stražnjeg medijastinuma; tumorski biljezi Neuroendocrine carcinoma; posterior mediastinum; tumor markers Prikazan je slucaj 64-godišnjeg bolesnika s tumorom stražnjeg gornjeg medijastinuma uz racvište dušnika. Mikroskopski, tumor je graden od angiocentricno poredanih otoka stanica koje su na periferiji visoke, cilindricne, te stvaraju Flexner-Wintersteiner rosete i palisade, dok su u središtu poligonalne, s bizarnim multilobuliranim oblicima jezgri, visokom mitotickom aktivnošcu i znatnom nekrozom. Grimelius metodom dokazana su argentafilna tjelešca u jezgri. Imunohistokemijski, tumorske stanice su izrazito pozitivne na epitelne i neuroendokrine markere EMA, Cytokeratin MNF-116, NSE, S-100 i Chromogranin-A, dok su CD-99, TTF-1, Vimentin i p-21 negativne. Obzirom na opisanu histološku sliku, tumor je dijagnosticiran kao rijetki primarni neuroendokrini karcinom velikih stanica smješten u stražnjem gornjem medijastinumu. A tumor mass was noted in the posterior mediastinum on the tracheal bifurcation in a 64-year- old man. Microscopically the tumor consisted of angiocentric atypical cylindrical epithelial cells that often form Flexner-Wintersteiner rosette and palisade. In the centre of the tumor island the cells were polygonal and showed bizzare multinucleated nuclei with marked necrosis and mitotic activity. The argentafillic bodies were identified by the Grimelius method. Immunohistochemically, the tumor cells expressed both epithelial and neuroendocrine markers, including Cytokeratin MNF-116, EMA, NSE, S-100, Synaptophysin and Chromogranin A; while CD-99, TTF-1, Vimentin, p-21 were negative. The described tumor was diagnosed as a rare, primary neuroendocrine carcinoma of large cells in the upper posterior med General hospital Zadar 2008-05-05 text pdf http://hrcak.srce.hr/22835 http://hrcak.srce.hr/file/35957 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.38 No.1-2; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:22836 2008-06-03 journal:31

Vjerodostojnost alkotestiranja koncentracije alkohola u izdahu, upotrebom Dräger Alcotest 7410Plus alkometra, kod utvrdivanja alkoholiziranosti u sudskom postupku Reliability of breath alcohol testing with Dräger Alcotest 7410Plus analyzer in a court process Kovačić, Zdravko; Zagreb University Faculty of Medicine Forensic Medicine and Criminology Institute Nestić, Marina; Zagreb University Faculty of Medicine, Forensic Medicine and Criminology Institute Stemberga, Valter; Rijeka Faculty of Medicine Forensic Medicine Institute Bosnar, Alan; Rijeka Faculty of Medicine Forensic Medicine Institute Petrovečki, Marko; Zagreb Faculty of Medicine student Sutlović, Davorka; Split Clinic Hospital Center, Forensic Medicine Clinic Department; dsutlov@kbsplit.hr dräger alkotest 7410Plus; koncentracija alkohola u izdahu; koncentracija alkohola u krvi; sudska toksikologija; sudski postupak Dräger Alcotest 7410Plus; breath alcohol concentration (BrAC); blood alcohol concentration (BAC); forensic toxicology; court process Mogucnost primjene rezultata alkotesta Dräger 7410Plus kao zamjene za analizom utvrdene koncentracije alkohola u krvi i mokraci. U radu je obradeno 570 slucajeva koji se temelje na podacima dobivenim iz sudskih spisa gdje je vozacu nakon alkometrom utvrdene prisutnosti alkohola u izdahnutom zraku, upotrebom alkotesta Dräger Alcotest 7410Plus, metodom plinske kromatografije utvrdena koncentracija apsolutnog alkohola u krvi i mokraci. U svim obradenim slucajevima alkohol se nalazio u fazi eliminacije iz organizma. Analizom utvrdene koncentracije alkohola u krvi retrogradno su preracunate na vrijeme testiranja alkometrom i usporedene. Usporedbom rezultata Drägera i analizom utvrdene koncentracije alkohola u krvi preracunate na vrijeme alkotestiranja proizlazi da se 30 od 570 ispitanika (5,3%) ne nalazi unutar granice 95% predikcije jednadžbe pravca CBAC ± 0,307 = 0,093 + 1,022CBrAC Na osnovi provedenog ispitivanja može se odrediti koncentracijsko podrucje unutar kojeg bi se s 95%-om vjerojatnošcu morala nalaziti koncentracija alkohola u krvi pod pretpostavkom da je krv uzeta na analizu u vrijeme alkotestiranja. Sudskomedicinska klasifikacija stanja alkoholiziranosti odnosi se na koncentraciju alkohola u krvi, a ne u izdahu, te stoga na osnovi rezultata alkometra (koncentracije alkohola u izdahu) nije moguce odrediti niti stanje alkoholiziranosti. The aim is to determine the usefulness and reliability of breath alcohol tests performed with Dräger Alcotest 7410Plus analyzer, in comparison to more complex analysis methods of blood and urine alcohol testing. A total of 570 cases were taken from archival court evidence material. In all cases, individuals were driving under the influence of alcohol (DUI), and breath alcohol tests performed with Dräger Alcotest 7410Plus analyzer were positive. After breath alcohol testing, all individuals underwent repeated blood and urine alcohol testing, but this time concentrations were measured by headspace gas chromatography. In all individuals alcohol was in its elimination phase. The results obtained from both experiments were evaluated and compared. Comparison of breath alcohol concentration and blood alcohol concentration calculated to the time of breath alcotest, showed that 30 of 570 individuals (5.3%) were not within 95% predicament range, according to the linear equation CBAC ± 0.307 = 0.093 + 1.022CBrAC. Legal classification of being under the influence of alcohol refers to blood alcohol concentration, not breath alcohol concentration. Therefore it is not plausible to define the state of alcohol influence using Dräger Alcotest 7410Plus analyzer. General hospital Zadar 2008-05-05 text pdf http://hrcak.srce.hr/22836 http://hrcak.srce.hr/file/35960 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.38 No.1-2; ISSN 0351-0093 (Print) en

oai:hrcak.srce.hr:22837 2008-06-03 journal:31

Kirurško liječenje velike ciste donje čeljusti Surgical treatment of large mandibular cyst Orihovac, Željko; Dubrava Clinic Hospital, Maxilofacial Surgery; zorihov@kbd.hr Vidaković, Bojan; Zagreb Faculty of Medicine student Vujnovac, Tena; Zagreb Faculty of Medicine student Cista; čeljust; diferencijalna dijagnoza; kirurško liječenje; rezultat Cysts; jaw; surgical treatment; differential diagnosis; result Ciste celjusti nisu rijetka pojava, ali, u odredenom broju slucajeva, nespecifican klinicki i radiološki nalaz mogu otežati njihovo rješavanje. Zbog toga je patohistološki nalaz nužan za postavljanje konacne dijagnoze. U radu je prikazan slucaj 67-godišnjeg pacijenta s velikom cistom mandibule koja je uspješno kirurški odstranjena. Pacijent se javio zbog otekline donje celjusti, a radiološkom obradom se utvrdi patološka prozracnost koja može odgovarati cisti celjusti ili ameloblastomu. Prvi patohistološki nalaz je takoder bio nespecifican i nije iskljucivao ameloblastom, koji se zbog sklonosti recidiviranju mora radikalnije tretirati. Stoga se pristupilo operativnom zahvatu tijekom kojeg se ucini intraoperacijska biopsija koja pokaže da se radi o cisti, a ne o ameloblastomu. Uradena je cistektomija mandibule, lezija je u potpunosti odstranjena, ukljucujuci i epitelnu ovojnicu, te se unatoc velikom defektu sacuvao kontinuitet kosti i nije bilo potrebe za osteosintezom i/ili osteoplastikom. Usprkos velicini defekta, bolesnikovoj dobi i cinjenici da ima bezubu celjust, defekt celjusti je najvecim dijelom ispunjen novostvorenom kosti. Zakljucujemo da je nužno prilagoditi opseg zahvata vrsti lezije, kako bi rezultati lijecenja bili optimalni. Cysts of the jaw are not a rare problem, however non-specific clinical and radiographic findings may complicate treatment. This is the primary reason that microscopic tissue evaluation is necessary to establish the diagnosis. We report a case of a 67-year-old patient with a large mandibular cyst that was successfully surgically removed. The patient suffered swelling of the mandible. Radiographic examination showed pathological transparency, which could represent an odontogenic cyst or ameloblastoma. The first microscopic examination was also non-specific and did not exclude ameloblastoma, which must be treated radically due to its tendency to recur. Intraoperative biopsy material proved it to be a cyst, and not an ameloblastoma. Cystectomy of the mandible was performed, and the lesion was removed completely, including the epithelial sheath. Despite the size of the cyst, bone continuity was maintained and there was no need for osteosynthesis or osteoplasty. The postoperative defect was filled with regenerated bone, despite its size, patient's age and the fact he was edentulous, and without disease recurrence. The authors concluded that it is necessary to adjust the extent of the intervention according to the type of lesion, thus optimizing treatment results. General hospital Zadar 2008-05-05 text pdf http://hrcak.srce.hr/22837 http://hrcak.srce.hr/file/35961 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.38 No.1-2; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:29481 2008-12-08 journal:31

Zadarsko zdravstvo u razdoblju od završetka Drugog svjetskog rata do danas (1945.-2008.) Zadar health care during the period from the end of the second world war until the present day (1945-2008) Dželalija, Boris; General hospital zadar, Department of infectology; boris.dzelalija@zd.t-com.hr Bošnjak, Ivana; Medical faculty Split, student Barbarić, Stjepan; Retired person Visković, Ante; Retired person Zadarsko zdravstvo; zdravstveni djelatnici; razvitak. Zadar health care, health care workers, development. U ovom radu, a na temelju zapisa u strucnim casopisima, monografijama i knjigama, prikazujemo razvitak zadarskog zdravstva u razdoblju od završetka Drugog svjetskog rata do danas (1945. – 2008.). Reorganizacija zdravstvene službe iz ratnih na minimalne mirnodopske uvjete rada pocela je stvaranjem stacionara u Bokanjcu 1944. i otvaranjem bolnice 1945. godine. Nova organizacija na pružanju zdravstvene zaštite sastojala se u uspostavljanju zdravstvenih stanica i ambulanti, organizaciji ljekarnicke djelatnosti, održavanju zdravstvenih tecajeva. Otvaranjem Gradsko-kotarske poliklinike 1948. ujedinjena je izvanbolnicka zdravstvena djelatnost, a otvaranjem Doma zdravlja 1952. godine ujedinjena je kurativna i preventivna izvanbolnicka djelatnost. Medicinski centar u Zadru, kao institucionalizirani oblik integralne zdravstvene zaštite, formiran je 1962. godine. Duševna bolnica u Zemuniku, kao Psihijatrijski odjel Zadarske bolnice, otvorena je 1949., a Psihijatrijska bolnica Ugljan, kao azil za duševne bolesnike, 1955. godine. Djelatnost opskrbe lijekovima provodi Ljekarna Zadar od 1962. godine Zavod za zaštitu zdravlja, kao ustanova za potpunu i cjelovitu preventivnu i socijalno-medicinsku zdravstvenu zaštitu, formiran je 1984. godine. Medicinski centar Zadar razdvojen je 1993. godine na Opcu bolnicu i Dom zdravlja. Strucna knjižnica Opce bolnice Zadar, strucni casopis Medica Jadertina, Znanstvena jedinica i Hrvatski lijecnicki zbor – podružnica Zadar omogucili su uvjete za strucni i znanstveni rad zdravstvenih djelatnika. Tijekom Domovinskog rata (1991. – 1995.) zdravstvenu skrb ranjenicima i bolesnicima pružali su djelatnici u Opcoj bolnici, gradskim i terenskim ambulantama i zdravstveni djelatnici angažirani u pokretnim medicinskim ekipama ukljucenim u borbene postrojbe Zbora narodne garde, Hrvatske vojske i Ministarstva unutarnjih poslova. U razdoblju od završetka Drugog svjetskog rata do danas zadarsko zdravstvo je u stalnom usponu u stvaranju strucnih i znanstvenih kadrova i tehnickoj opremljenosti. In this work, which is based on records from professional magazines, monographs and books, we show the development of Zadar health care in the period from the end of the Second World War until the present day (from 1945 to 2008). The reorganization of health care service from war conditions to minimal working conditions in peacetime started with the formation of an in-patient clinic in Bokanjac in 1944 and the opening of a hospital in 1945. The new organization of health care consisted of setting up in-patient clinics and surgeries, organization of pharmaceutical activities, and holding health care courses. The opening of a city-district polyclinic in 1948 united the out-patient health care activity, and the opening of a Health Center in 1952 united the out-patient curative and preventive activities. Medicinski centar (Medical Center) in Zadar as an institutionalized form of integral health care was established in 1962. The Psychiatric Hospital in Zemunik, as Department of Psychiatry of Zadar Hospital was opened in 1949, while Ugljan Hospital of Psychiatry, as an asylum for mental patients, was opened in 1955. The drug supply activity has been carried out by Ljekarna Zadar since1962. The Health Care Institute, as an establishment for the complete and entire prevention and social and medical health care, was established in 1983.. Medicinski centar Zadar was divided in 1998 into General Hospital and Health Center. Zadar General Hospital Scientific Library, the professional magazine Medica Jadertina, Scientific Unit and Croatian Medical Association Branch Office Zadar have rendered possible the conditions for professional and scientific work of health care workers. During the Croatian War of Independence (1991-1995) health care was given to the injured and sick by workers in General Hospital, city and field surgeries and health care workers engaged in moveable medical teams as part of the fighting units of the Croatian National Guard, Croatian Army and Ministry of Internal Affairs. In the period from the end of the Second World War until today, Zadar health care is continually on the rise in creating expert and scientific personnel and technical equipment. General hospital Zadar 2008-12-01 text pdf http://hrcak.srce.hr/29481 http://hrcak.srce.hr/file/46353 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.38 No.3-4; ISSN 0351-0093 (Print) hr

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Sindrom karpalnog tunela - suvremena dijagnostika i liječenje Carpal tunnel syndrome - modern diagnostic and therapy Crnković, Tomislav; General hospital Požega; tomislav_crnkovic@inet.hr Bilić, Ranko; Clinic of orthopedics from Medical faculty University of Zagreb Kolundžić, Robert; Clinic of orthopedics, Medical faculty University of Zagreb Sindrom karpalnog tunela, dijagnostika, liječenje. Carpal tunnel syndrome, diagnostics, therapy. Sindrom karpalnog tunela najcešca je kompresivna neuropatija na ljudskom tijelu koja se manifestira ispadima u inervacijskom podrucju živca medianusa s ucestalošcu izmedu 50 i 150 slucajeva na 100.000 stanovnika. Simptomatika ovisi o trajanju i jacini kompresije živca. Smetnje senzibilnosti prvi su i najstalniji simptom, dok motoricke smetnje nastaju u bolesnika s dugotrajnom kompresijom živca. Elektroneurofiziološka dijagnostika "zlatni je standard” u postavljanju dijagnoze, a potrebno ju je uciniti kod svake klinicke sumnje na sindrom karpalnog tunela. Kao dodatna dijagnosticka sredstva u atipicnim slucajevima mogu poslužiti ultrazvuk i magnetska rezonancija karpalnog tunela. Neoperacijsko lijecenje rezervirano je za lakše oblike kompresije živca, te kod pojave sindroma u tranzitornim stanjima, kao što su trudnoca, laktacija, korištenje oralnih kontracepcijskih sredstava i sl. Metoda izbora za perzistentne i progresivne oblike sindroma karpalnog tunela, kao i za one koji ne reagiraju na konzervativnu terapiju, operacijsko je lijecenje. Dekompresija živca medianusa efikasan je i siguran zahvat koji u najvecem broju slucajeva oslobada pacijenta od tegoba. Sam zahvat može se izvršiti metodom "otvorenog polja” ili endoskopski, iako za sada nema pokazatelja o prednosti endoskopske tehnike u odnosu na klasicnu tehniku "otvorenog polja”, a jatrogena oštecenja živca medianusa daleko su cešca pri endoskopskoj tehnici. U svakodnevnoj praksi najvece znacenje ima rano prepoznavanje sindroma karpalnog tunela, te njegovo pravodobno i adekvatno lijecenje. U suprotnom dolazi do nepotrebno dugog trajanja smetnji za pacijenta i težeg oštecenja živca, što smanjuje izglede uspješnog lijecenja, te dovodi do nepotrebnih ekonomskih gubitaka. Carpal tunnel syndrome is the most common compressive neuropathy in the human body, which is expressed by a deficit in the median nerve innervation area, with prevalence of 50 to 150 cases per 100.000 inhabitants. Symptoms depend on nerve compression duration and intensity. Sensibility disorders are the first and one of the most persistent symptoms, while motoric disorders arise in patients with prolonged nerve compression. Electroneurophysiological diagnostics is a "golden standard” in diagnosis setting, and it is necessary to be done in every patient with a clinical doubt on carpal tunnel syndrome. Additional diagnostics means in atypical cases can be performed by ultrasound and magnetic resonance of the carpal tunnel. Non-surgical treatment is reserved for mild forms of nerve compression, and in cases of syndrome in temporary conditions like pregnancy, lactation, taking oral contraceptives etc. The method of choice for persistent and progressive forms of carpal tunnel syndrome, as well for those who don't respond to the conservative treatment, is surgery. Decompression of median nerve is an efficient and secure procedure, which, in most cases, releases the patient from its symptoms. Procedure can be performed by an "open field” method or via endoscopy, although, for now, no indicators on advantages of endoscopic technique vs. classical technique of an "open field” have been found, and iatrogenous damage of the median nerve are much more frequent in surgery via endoscopy. In everyday practice, the most important is early recognition of the carpal tunnel syndrome, and its timely and adequate treatment. On the contrary, unnecessaryprolongation of the condition leads to much more severe nerve damage, which diminishes chances for a successful treatment and causes necessary economy losses. General hospital Zadar 2008-12-01 text pdf http://hrcak.srce.hr/29482 http://hrcak.srce.hr/file/46355 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.38 No.3-4; ISSN 0351-0093 (Print) hr

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Analiza povijesti bolesti nakon specijalističkog pregleda: Postoje li razlike u strukturi i sadržaju povijesti bolesti u razdoblju od 1999. do 2004. godine Disease analysis after specialist examination: are there any differences in the medical history structure and contents in the period from 1999 to 2004 Amerl-Šakić, Vjekoslava; Health station Jarun, Zagreb Povijest bolesti, specijalistički pregled. Medical history, specialist exam. Necitke i nepotpune povijesti bolesti napisane od strane specijalista konzilijarno-poliklinicke službe veliki su teret lijecniku obiteljske medicine. U ambulanti primarne zaštite na podrucju Trešnjevke u periodu od 1. 1. do 31. 12. pregledavana je medicinska dokumentacija izdana bolesnicima tijekom 1999. i 2004. godine od strane specijalista internisticke i kirurške grupe medicinskih djelatnosti. Od ukupnog broja od 4288 povijesti bolesti svega ih je 2326 ili 54,24% potpuno i citko napisanih dok je 864 ili 20,14% napisano rukom i više ili manje su necitke za vecinu lijecnika. Prema dobivenim podacima nakon više od 45% svih pregleda specijalista, lijecnik obiteljske medicine ne dobiva potpunu informaciju o stanju svog bolesnika. Iako je ukupni postotak bez pravilno napisane dijagnoze visok (12,55%), još više zabrinjava podatak o 13,06% povijesti bolesti bez potpuno napisane terapije. Ohrabruje cinjenica da je uocen pozitivni pomak od 7,85%, jer se 2004.g. cešce pišu potpune povijesti bolesti. Statisticki najznacajnija razlika uocena je u skupini povijesti bolesti bez potpuno napisane terapije, gdje u 2004. specijalisti internistickih grana za 3,06% cešce u odnosu na 1999. pišu terapiju. Statisticki znacajna razlika uocena je kod usporedbe nalaza napisanih 2004. i 1999. unutar internisticke, odnosno kirurške grane. Provedena analiza je pokazala kako je u procesu upucivanja u razdoblju od 1999. do 2004. došlo do poboljšanja komunikacije lijecnika koji u tome sudjeluju, no ima još mnogo mjesta za daljnje poboljšanje kvalitete. Illegible and incomplete medical histories written by consultative polyclinic specialists are a great problem for family physicians. In the primary care unit in Trešnjevka, in the period from January 1 to December 31, medical histories issued to patients by internists and surgeons in 1999 and 2004 were reviewed. Out of a total number of 4,288 medical histories, only 2,326 (54.24%) were complete and legible, whereas 864 (20.14%) were written by hand and more or less illegible for most physicians. According to the data obtained after more than 45% of all specialist exams, the primary care physician did not receive complete information regarding his/her patient's state. Though the total percentage without a correctly written diagnosis was high (12.55%), an even more worrisome fact was the 13.06% of medical histories without a completely specified therapy. A positive increase of 7.85% was noted, since in 2004 complete medical histories were entered more frequently. Statistically, the most significant difference was noticed in the medical histories without a fully specified therapy, where in 2004 internists wrote the therapy 3.06% more frequently in relation to 1999. A statistically significant difference was noted in comparing medical histories written in 2004 and 1999 among both internists and surgeons, and overall. General hospital Zadar 2008-12-01 text pdf http://hrcak.srce.hr/29483 http://hrcak.srce.hr/file/46357 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.38 No.3-4; ISSN 0351-0093 (Print) hr

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Prognostičko značenje ekspresije Ki-67 antigena u bolesnika s uvejalnim melanomom Predictive power of Ki-67 antigen expression in patients with uveal melanomas Krvavica, Ana; General hospital Zadar, Department of pathology and forensic medicine; ana.krvavica@zd.htnet.hr Ki-67 onkogen, melanocitna proliferacija, melanomi uveje, tumorski biljezi. Ki-67 oncogen, melanocyte proliferation, uveal melanoma, tumor markers. Cilj ove kratke studije bio je utvrditi izražajnost Ki-67 kao cimbenika proliferacije u stanicama melanoma srednje ocne ovojnice, ispitati je li intenzitet izražajnosti povezan s morfološkim tipom stanica, te utvrditi je li intenzitet izražajnosti u svezi sa stupnjem invazije, što bi moglo imati prognosticki znacaj. Za ispitivanje jacine izražajnosti Ki-67 proteina indirektnom peroksidaza-antiperoksidaza metodom i monoklonalnim antitijelom za Ki-67 protein pregledano je 30 melanoma srednje ocne ovojnice. Jacina izražajnosti reakcije je obilježena semikvantitativnom metodom kao: negativna, slabo pozitivna, umjereno i jako pozitivna. Imunološka reakcija je bila negativna u 3 melanoma vretenastih stanica i jednom epiteloidnih stanica, slabo pozitivna u 3 tumora vretenastih stanica; umjereno pozitivna u 6 tumora vretenastih stanica, 6 miješane grade i 3 epiteloidnih stanica. Reakcija je bila najjaceg intenziteta u jednom melanomu vretenastih stanica, 6 miješane grade i jednom epiteloidne grade. U našem uzorku tumora pT2 stadija vecina tumora pokazala je umjereno jaku reakciju (30%), a manji broj slabo pozitivnu (6,6%), ali u pT3 stadiju 26,7% tumora je pokazalo najjaci intenzitet reakcije. The aim of this short study was to investigate the expression of Ki-67 immunocomplex in uveal melanoma cells, to examine if the expression intensity corellates with the morphologic cell type, to establish if the expression intensity corellates with the invasion levels which would result in prognostic significance. 30 uveal melanomas were examined in order to test the presence of Ki-67 protein by indirect peroxidaseantiperoxidase method and monoclonal antibody for Ki-67 protein. The intensity of the reaction was marked negative, weakly positive, moderately positive or strongly positive by the semiquantitative method. The immunoreaction was found to be negative in 3 spindle cell melanomas and 1 epitheloid; weakly positive in 3 spindle cell melanomas, moderately positive in 6 spindle cell melanoma, 6 of mixed cellularity and 3 of epitheloid type. The intensity was strongest in 1 spindle cell, 6 tumors of mixed cellularity and one epitheloid. In our samples from the pT2 stage most tumors were moderately positive (30%), and a minor number of cases were weakly positive (6,6%), but in the pT3 stage 26,7% of tumors showed the strongest intensity of reaction. General hospital Zadar 2008-12-01 text pdf http://hrcak.srce.hr/29484 http://hrcak.srce.hr/file/46359 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.38 No.3-4; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:29500 2008-12-09 journal:31

Udio, značajke i opravdanost kućnih posjeta u radu liječnika obiteljske medicine koji zbrinjavaju stanovništvo seoskog područja Hrvatske The role, characteristics and justification of home visits in the work of family medicine doctors who practice in rural Croatia Jurković, Ljiljanka; Health station Dugave, Zagreb Lazić, Đurđica; University Zagreb, Medical faculty Dodig, Željko; Ambulance for family medicine Bošnjaci Madunić-Majnarić, Ivanka; Ambulance for family medicine Kloštar Ivanić Đanić, Nives; Ambulance for family medicine Virje Kralj, Diana; Ambulance for family medicine Draganići Barišić-Marčac, Zdenka; Ambulance for family medicine Generalski Stol Obiteljski liječnik; kućne posjete. General practitioner; home visits. Kucne posjete (KP) bitna su znacajka rada lijecnika obiteljske medicine (LOM). Upravo je zbrinjavanje bolesnika izvan zdravstvene ustanove jedna od temeljnih razlika medu lijecnicima koji rade u bolnicama i LOM-a. Tijekom kucne posjete lijecnik i bolesnik susrecu se na najneposredniji nacin. Porast prevalencije kronicnih bolesti i smanjenje funkcionalne sposobnosti dijela populacije radi starenja uzrokuju sve vecu potrebu za zbrinjavanjem bolesnika u kuci. Cilj rada bio je analizirati udio KP u ukupnim posjetima pacijenata u skrbi LOM-e u seoskom podrucju, utvrditi znacajke i opravdanost KP koje su obavili pet LOM-e, te analizirati najcešca stanja, odnosno bolesti zbog kojih LOM ide u KP. Podaci o ukupnom broju posjeta ordinaciji LOM-a, i podaci o broju obavljenih KP prikupljeni su iz mjesecnih izvješca o radu LOM-a koja se redovito upucuju Hrvatskom zavodu za zdravstveno osiguranje (HZZO). Podaci o dobi, spolu, vrsti KP i morbiditetu prikupljeni su iz knjige kucnih posjeta. Pored toga, dva su lijecnika nakon obavljene KP procijenila i evidentirala u knjigu kucnih posjeta opravdanost obavljene KP. Podaci su obradeni postupcima deskriptivne statistike i prikazani numericki i graficki. Od ukupno 58.995 ambulantnih posjeta ordinacijama OM, lijecnici su napravili 1970 KP (3,3%), najcešce osobama starije dobi (85,4% posjeta) i ženama (65,2% posjeta). Najcešci razlozi KP bile su kardiovaskularne bolesti, bolesti lokomotornog sustava, te novotvorevine. Dva su lijecnika procijenila da je neopravdanih KP bilo kod jednoga 49,4%, odnosno 18,8% kod drugoga lijecnika. Iako je prema statistickim izvješcima prisutan trend smanjenja broja KP, lijecnici OM pružaju ih u skladu sa standardom posjeta Hrvatskog zavoda za zdravstveno osiguranje, što ukazuje na cinjenicu da su KP i dalje važan djelokrug rada LOM-a. Home visits (HVs) represent an essential characteristic of Family Medicine practice (FMP). In fact, patient management outside healthcare facility accounts for the fundamental difference between hospital and Family Medicine practice. During the course of a home visit, the physician and the patient get into an immediate contact. The rise in prevalence of chronic diseases and the reduction of functional capabilities encountered in some population segments due to aging, impose a steadily increasing need for homecare and home treatment. This study aims at analysing the frequency, role and characteristics of all patient HVs made by five FMPs in rural areas. Further on, this study aims to describe the characteristics and justify HVs and analyse the common diseases treated by five MFCs. Surgery treatment data and HVs data were completed from the five FMPs’ monthly reports which were also sent to the Croatian Health Insurance Company. The data on age, gender and HVs, and morbidity rate were collected from the HV evidence book. Moreover, after performing HVs two FMPs estimated and evaluated the justification of the HV, which was registered in the HV register. The data were evaluated using descriptive statistical methods, and displayed both numerically and graphically. Out of 58,995 outpatient visits, the FMPs in reference made a total of 1,970 HVs (3.3%), most frequently conducted among elderly patients (85.4% of all visits) and women (65.2% of all visits). The most common reasons for these HVs were cardiovascular and locomotive conditions and neoplasmas. Two FMPs concluded that 49.4% HVs were unjustified by one doctor and 18.8% by the second one. Despite the trends towards the decrease in number of HVs, highlighted by statistical reports, FMPs provide those services in line with the pertinent standard established by the Croatian Institute of Health Insurance, suggesting that HVs still represent an important aspect of FM practice. General hospital Zadar 2008-12-01 text pdf http://hrcak.srce.hr/29500 http://hrcak.srce.hr/file/46391 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.38 No.3-4; ISSN 0351-0093 (Print) hr

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Terapijski pristup atelektazi u djece Treatment of atelectasis in children Raos, Miljenko; Hospital for children Srebrnjak, Zagreb; miljenko.dr.raos@zg.t-com.hr Batinica, Stipe; Medical clinical centar Rebro, Department of Surgery for children, Zagreb Marković, Jelica; Hospital for children, Zagreb Atelektaza; dijete; liječenje. Atelectasis; child; therapy. Atelektaza oznacava bezracni dio veceg ili manjeg dijela pluca. Popratna je pojava u tijeku niza plucnih bolesti. Najcešci uzrok atelektaze je opstrukcija dišnog puta, kompresija plucnog parenhima, nedostatak ili disfunkcija surfaktanta. Lijecenje ovisi o uzroku. Najcešce se provodi respiratorna fizioterapija, inhalacije bronhodilatatora, sekretolitika, razlicite tehnike povišenog ekspiracijskog tlaka, fleksibilna bronhoskopija, te kirurško lijecenje. U radu su prikazana tri bolesnika s atelektazom. Kod jednog bolesnika radilo se o akutnoj atelektazi u tijeku egzacerbacije astme, koja je riješena fleksibilnim bronhoskopom. Kod dva bolesnika radilo se o kronicnoj atelektazi, gdje je bilo indicirano kirurško lijecenje – lobektomija, koja je ucinjena kod jednog bolesnika, dok kod drugoga roditelji nisu prihvatili kirurško lijecenje. Atelectasis is a collapsed or airless state and may involve all or part of the lung. Many lung diseases can be associated with atelectasis. It occurs most commonly with bronchoobstruction, lung parenchyma compression, surfactant deficiency or disfunction. Atelectasis treatment depends on the cause. Chest physiotherapy is carried out most often. Bronchodilatator and secretolytics inhalation, various techniques of increased expiratory pressure, flexibile bronchoscopy and surgery, respectively, are often performed. In the present paper three cases of atelectasis in children are presented. In the first patient atelectasis appeared during acute asthmatic exacerbation, and it was cured by flexibile bronchoscopy. Lobectomy was indicated in the other two children with chronic atelectasis, but it was performed in one patient, while the parents of the second child did not give their consent for surgical treatment. General hospital Zadar 2008-12-01 text pdf http://hrcak.srce.hr/29502 http://hrcak.srce.hr/file/46395 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.38 No.3-4; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:29505 2008-12-09 journal:31

Mukokela čeonog sinusa kao posljedica ratne ozljede The frontal sinus mucocele as war injury consequence Grabovac, Stjepan; General hospital Bjelovar, Department for diseases of ear, neck and nose; stjepan.grabovac@bj.t-com.hr Košćak, Kristina; General hospital Bjelovar, Department for diseases of eyes diseases Mukokela čeonog sinusa; ratna ozljeda. Frontal sinus mucocele; war injury. Mukokela ceonog sinusa je benigna, epitelom obložena tvorba ispunjena sluzavim sadržajem koja pokazuje tendenciju širenja i razaranja okolnih koštanih struktura. Može nastati kao posljedica ozljede ceonog sinusa mnogo godina kasnije, kao rijetka i ozbiljna komplikacija zbog poremecene drenaže i aerizacije sinusa uzrokovane suženjem izvodnog kanala sinusa. U radu smo opisali bolesnika s velikom mukokelom ceonog sinusa koja je nastala kao kasna posljedica ratne ozljede glave u predjelu cela i nosa 13 godina nakon ranjavanja. Zbog bolova u lijevom oku upucen je oftalmologu. Na CT-u orbita dijagnosticirana je oštro ogranicena mekotkivna lezija promjera 30 mm, što upucuje na mukokelu u lijevom ceonom sinusu koja se širila van koštanih granica i pritiskala oko. Pacijent je lijecen kombinacijom endoskopskog i otvorenog kirurškog pristupa. A frontal sinus mucocele is a benign formation covered with mucous content epithel, which shows a tendency of spreading and surrounding bone structure destruction. It can appear as a consequence of frontal sinus injury many years later as a rare and serious complication due to drainage and aerisation disturbance caused by sinus duct narrowing. The article describes a patient with a big frontal sinus mucocele, which appeared as a late war injury consequence in the forehead and nose area 13 years after the injury. Due to pain in the left eye, the patient was referred to an ophthalmologist. The CT demonstrated a sharply edged, soft tissue lesion of 30mm in diameter, which refers left frontal sinus mucocele spreading outside the bone borders and pressing the eye. It was treated by a combination of endoscopic and open surgical approach. General hospital Zadar 2008-12-01 text pdf http://hrcak.srce.hr/29505 http://hrcak.srce.hr/file/46399 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.38 No.3-4; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:29507 2008-12-09 journal:31

Ivo Jajić, Zrinka Jajić i suradnici: Fizikalna i rehabilitacijska medicina: osnove i liječenje, Medicinska naklada, Zagreb, 2008. Sekelj-Kauzlarić, Katarina; Nacionalna predstavnica u Vijeću Europske unije medicinskih specijalista General hospital Zadar 2008-12-01 text pdf http://hrcak.srce.hr/29507 http://hrcak.srce.hr/file/46402 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.38 No.3-4; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:37768 2009-06-10 journal:31

Spolni hormoni i seksualna želja Sex hormones and the sexual desire Šimić, Nataša; University Zadar, department for psychology; nsimic@unizd.hr spolni hormoni; testosteron; andropauza; menstrualni ciklus; libido; seksualna motivacija sex hormones; testosterone; andropause; menstrual cycle; libido; sexual motivation U ovom radu raspravlja se o efektima spolnih hormona na seksualno funkcioniranje kod muškaraca i žena. Iako androgeni hormoni ne reguliraju u potpunosti seksualno ponašanje, dosadašnja istraživanja ukazuju na njihov utjecaj na seksualnu motivaciju kod muškaraca i žena. U radu se takoder raspravlja o efektima hormonalne nadomjesne terapije na razlicite aspekte seksualnog funkcioniranja kod muškaraca i žene, te se ukazuje na metodološke probleme u provedenim studijama. Navode se takoder rezultati dosadašnjih istraživanja o hormonalnim promjenama, kao i promjenama u razlicitim aspektima seksualnosti, koje se dogadaju u funkciji dobi, s posebnim naglaskom na relacije izmedu testosterona i seksualne motivacije. Citiraju se takoder rezultati dosadašnjih istraživanja promjena seksualne želje i drugih aspekata seksualnosti tijekom menstrualnog ciklusa, te se navode smjernice za buduca istraživanja. This paper discusses the effects of sex hormones on sexual functioning in men and women. Even though androgen hormones do not completely regulate sexual behaviour, former investigations have shown their influence on sexual motivation in men and women. The paper also discusses the effects of hormone substitute therapy on various aspects of sexual functioning in men and women, and points out the methodological problems in the carried out studies. Results of up-to-date researches on hormone changes are stated, as well as changes in various aspects of sexuality that take place at a functional age, with particular emphasis on the testosterone and sexual motivation relation. Results of up-to-date researches on sexual desire changes and other aspects of sexuality during the menstrual cycle are quoted, and directions for future researches are mentioned. General hospital Zadar 2009-06-01 text pdf http://hrcak.srce.hr/37768 http://hrcak.srce.hr/file/59351 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.39 No.1-2; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:37769 2009-06-10 journal:31

Vrijednosti laboratorijskih testova za dokaz preosjetljivosti kod bolesnika s pozitivnim kožnim testom na kućnu prašinu i grinje Laboratory test values as proof of hipersensitivity in patients with positive dermatological test on home dust and house dust mites Skitarelić, Nataša; General Hospital Zadar, Department for pediatry Mišulić, Joško; General Hospital Zadar, department for pediatry, Zadar, Croatia Skitarelić, Neven; General Hospital Zadar, Department for Otorhinolaryngology, Zadar, Croatia Vuletić, Ana; General Hospital Zadar, Department for medical biochemistry, Zadar, Croatia Troskot, Vanja; General Hospital Zadar, department for pediatry, Zadar, Croatia atopija; laboratorijski testovi; kućna prašina atopy; laboratory tests; house dust Uvod: Alergijske bolesti su danas u izrazitom porastu. Unatoc tome što su testovi za dokaz alergije vec dugo prisutni u svakodnevnoj praksi, dijagnoza alergije i dalje ostaje složena s obzirom da ne postoji jedinstven i egzaktan test za dokazivanje preosjetljivosti. Svrha našega rada bila je ispitati vrijednost svakodnevnih laboratorijskih dijagnostickih testova na skupini djece s preosjetljivošcu na kucnu prašinu i grinje. Bolesnici i metode: Prospektivno ispitivanje provedeno je u Službi za zaštitu zdravlja djece Opce bolnice u Zadru, a obuhvatilo je skupinu od 64 djece oboljele od astme i drugih alergijskih bolesti s preosjetljivošcu u prick testu na kucnu prašinu i grinje. Svim ispitanicima uzeta je detaljna obiteljska i osobna anamneza, ucinjen je klinicki pregled, objektivno mjerenje plucne funkcije spirometrijom u djece starije od 7 godina, te kožno testiranje. Svi ispitanici testirani su metodom uboda u volarnu stranu podlaktice na kap alergena. Odredena su i ukupna i specificna IgE protutijela, broj eozinofilnih granulocita u perifernoj krvi, Dunger test, citološki obrisak sluznice nosa, te serumski eozinofilni kationski protein. Statisticka obrada podataka ucinjena je na osobnom racunalu, a statisticki znacajnim držane su vrijednosti P < 0.01. Rezultati: Oboljela djeca bila su u dobi od 4 do 15 godina života. Od 64 djece, njih 39 (61%) bilo je muškog spola, dok je 25 djece (39%) bilo ženskog spola. Obiteljska anamneza bila je pozitivna na alergiju kod 28 (44%) oboljele djece. Kod 24 od 64 (37%) bolesnika uz kucnu prašinu i grinje, dokazana je i preosjetljivost na jedan ili više peludnih alergena. Vecina oboljele djece, imala je klinicke simptome rinitisa ili rinitisa u kombinaciji s konjunktivitisom. Od ukupnog broja oboljele djece vecina živi u gradskoj sredini. Statisticki znacajnim za dokaz preosjetljivosti na kucnu prašinu kod oboljele djece pokazali su se: povecani broj eozinofila u citološkom obrisku nosne sluznice, ImmunoCAP Total IgE (ukupni IgE) i UniCAP test (specificni IgE), P < 0.01. Zakljucak: Tri od ispitivanih šest laboratorijskih dijagnostickih testova, pokazalo je visoku specificnost za potvrdu alergije kod bolesnika s preosjetljivošcu na kucnu prašinu u kožnom testu. Sva tri navedena testa neophodna su u svakodnevnom radu s atopicarima. Introduction: Allergies are on the rise today. Besides the fact that allergy tests are present in daily practice, allergy diagnosis is still complicated considering that there is no unique and exact test for hipersensitivity proof. The aim of our work is to test the values of daily laboratory diagnostics tests on a group of children with hipersensitivity to house dust. Patients and Methods: A prospective test was performed in the Child Health Protection Department of Zadar General Hospital which consisted of 64 children suffering from asthma and other allergy diseases with hypersensitivity in prick test on house dust and maggots. A detailed family and personal history was taken from all the children, clinical exam performed, objective lung spirometry measurement in children older than 7 and skin testing. All examinees were tested by the method of pricking the volar part of the forearm with allergen drops. Total and specific IgE antibodies were stablished, the number of eosinophilic granulocytes in peripheral blood, Dunger test, cytological swabs of the nose mucuous membrane and serum eosinophile catheon protein. Statistical data processing was erformed on a PC, and the values P < 0.01 were considered statistically significant. Results: The sick children were from 4 to 15 years of age: among the 64 children 39 (61%) were of male gender, while 25 children (39%) were of female gender. The family history was positive on allergies with 28 (44%) of the sick children. Besides house dust and maggots, 24 of the 64 (37%) patients proved hipersensitive to one or more pollen allergens. Most of the patients had clinical symptoms of rhinitis or rhinitis combined with conjunctivitis. Most of the afflicted children live in an urban environment. An increased number of eosinophiles in the cytological swap of nose mucuous, ImmunoCAP Total IgE and UniCAP test, P < 0.01 were statistically significant proof of hipersensitivity to house dust and maggots with afflicted children. Conclusion: Three out of six laboratory tests of the skin have shown high particularity in confirming allergy with patients that are hypersensitive to house dust. All three aforesaid tests are inevitable in the daily work with atopists. General hospital Zadar 2009-06-01 text pdf http://hrcak.srce.hr/37769 http://hrcak.srce.hr/file/59353 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.39 No.1-2; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:37770 2009-06-10 journal:31

Kineziološki programi u dječjim vrtićima kao sredstvo očuvanja djetetova zdravlja i poticanja razvoja Kinesiological programs in kindegartens as a way to keep health and stimulate child development Sindik, Joško; Children's nursery "Trnoružica", Zagreb, Croatia; josko.sindik@zg.t-com.hr djeca; kineziologija; potrebe; predškolski; program; razvoj children; kinesiology; needs; preschool; program; development Donošenje strategije za efikasnu prevenciju cesto je funkcionalnije nego rad na pojedinacnim slucajevima. U svrhu osiguranja zdravog razvoja predškolske djece, osmišljen je opci preventivni program s kvalitetno programiranim i planiranim kineziološkim aktivnostima. Opci kratkorocni cilj programa je poticanje cjelokupnog psihofizickog razvoja djece, dok mu je dugorocni cilj stjecanje korisnih i zdravih navika življenja. Osnovni oblik provodenja ovakvog programa je igraonica. Detaljno su opisani principi ustroja igraonica s ineziološkim sadržajima, ciljevi programa, sadržaji rada i oblici njegova provodenja, neki postignuti rezultati, te implikacije na ogucnost djetetovog bavljenja kineziološkim aktivnostima u buducnosti. Making efficient prevention strategy is often more functional than working on individual cases. A general preventive program with qualitative programmed and planned kinesiological activities was considered for the purpose of insuring healthy development of reschool children. The general short-term aim of the program is to stimulate child psychosomatic development as a whole. The long-term aim is to accept useful and healthy habits important for living. The basic form of the program realisation is a workshop (play shop). Basic principles of the organization workshops with sport contents are described in detail, as well as the program's realization aims and forms, some achieved results, and implications on the choices for a child’s involvement in kinesiological activities in the future. General hospital Zadar 2009-06-01 text pdf http://hrcak.srce.hr/37770 http://hrcak.srce.hr/file/59355 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.39 No.1-2; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:37772 2009-06-10 journal:31

P - 16 INK4a kao pokazatelj cervikalne displazije p - 16 INK4a as a marker for cervical dysplasia Krvavica, Ana; General Hospital Zadar, Department for pathology and forensic medicine, Zadar, Croatia; ana.krvavica@zd.htnet.hr cervikalna intraepitelna neoplazija; cervikalni karcinom; HPV; p-16 cervical intraepithelial neoplasia; cervical cancer; HPV; Papa-test; p-16 U razdoblju 2002. – 2004. godine 58 bolesnika Poliklinike "Lozo" testirano je na HPV. 33 testirane osobe bile su negativne, a ostalih 25 pozitivno. 23 bolesnice su nastavile s lijecenjem, dok su ostale iskljucene iz daljnje obrade iz razlicitih razloga (odlazak u drugu ustanovu na lijecenje ili su izgubljene iz sustava pracenja). Nakon pripreme za imunohistokemijsku analizu s monoklonalnim mišjim protutijelom p-16INK4a (DAKO Cytomation, Danska) nakon demaskiranja antigena i vizualizacijskim sustavom EnVision TM etrogradno su pregledana 23 uzorka tkiva. Rezultati munohistokemijske analize prikazani su semi-kvantitativnom metodom od 0-3. 4 bolesnice su bile p-16INK4a negativne (1 je imala cervikalni polip, 3 šiljate kondilome rodnice bez atipija). Od 7 bolesnica s citološki dokazanim CIN I, 3 su pokazale negativnu reakciju na p-16, a ostale 4 fokalno pozitivnu reakciju u citoplazmi i jezgrama epitelnih stanica. Od 6 bolesnica s citološkim CIN II, 3 su bile negativne na bojenje s p-16, jedna je pokazala fokalno pozitivnu reakciju, dok su dvije imale jako izraženu pojavnost p-16INK4a. Jedna od 3 bolesnice s itološkim CIN III imala je negativnu reakciju, a ostale dvije pozitivnu reakciju jakog intenziteta. Jedina bolesnica s citološkim CIS imala je difuznu jako pozivnu reakciju s p-16INK4a. Od dvije bolesnice s nepoznatim rezultatom Papa-testa jednoj je patohistološki dijagnosticiran CIN I, a drugoj CIN III na konizatu, dok je reakcija na p-16INK4a bila fokalno pozitivna u citoplazmi epitelnih stanica. Iz rezultata je vidljivo da je p-16INK4a bio pozitivan u svim stupnjevima displazije i klinicki evidentnog karcinoma (69,5%), a HPV je dokazan u svih bolesnica s citološkim CIN III. Stoga ova dva pokazatelja treba koristiti u preventivnim programima, uz ostale do sada poznate metode, jer omogucuju brzo, jednostavno i sigurno dokazivanje stupnja displazije. In the period 2002-2004, 58 patients from Lozo Health Center were tested for HPV, 25 of them were HPV positive, 33 negative. 23 patients continued with medical treatment, while the others were excluded from treatment (went to other institutions or their follow-up forms had been lost). After being prepared for immunohistochemical examination, all 23 tissue samples underwent retrograde immunohistochemical analysis with monoclonal mouse antibody p-16INK4a (DAKO Cytomation, Denmark) after antigen demasking and coupled with the DAKO En Vision TM visualisation system. The results of immunohistochemical analysis were presented with semiquantitative score system from 0- 3. Four patients were p-16INK4a negative (1 with cervical polyp and 3 vulvar condylomata without dysplasia.). Three from seven patients with cytologic CIN I were p-16 negative, while the remaining four showed focally positive expression in the cytoplasm and nuclei of epithelial cells. 3 patients out of 6 with cytologically evident CIN II showed negative reaction with -16, 1 focally positive reaction, while two were strongly showing p-16INK4a. In 1 case from 3 patients with CIN III p-16 had negative expression, while the other two showed a strongly positive xpression. The only case with cytologic CIS had a diffuse and positive reaction with p-16INK4a. 1 from 2 patients with an unknown Papa-test result was diagnosed CIN IHPV negative), while the other was diagnosed CIN III on the cervical conus, and p-16INK4a expression was focally positive in the cytoplasm of epithelial cells. From our results it is evident that p-16INK4a was positive in all tages of cervical dysplasia and clinically evident carcinoma CIS 69,5%),and HPV was confirmed with patients with CIN III. These two markers can therefore be used in prevention programmes with other currently known methods for they enable quick, simple and secure proof of the degree of dysplasia. General hospital Zadar 2009-06-01 text pdf http://hrcak.srce.hr/37772 http://hrcak.srce.hr/file/59358 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.39 No.1-2; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:37774 2009-06-10 journal:31

Obilna enteroragija kod bolesnice s Crohn-ovom bolesti Massive enterorrhagia in a patient with Crohn's disease Kozić, Mate; General Hospital Zadar, Department for internal medicine, Department for gastroenterology, Zadar, Croatia Crohn-ova bolest; obilno krvarenje Crohn's disease; massive bleeding Opisan je slucaj masivnog, po život opasnog, krvarenja kod 40-godišnje bolesnice s Crohn-ovom bolesti. Dijagnoza je postavljena MSCT-angiografijom i koloileoskopijom. Krvarenje je prestalo pontano. Tijekom 3 godine pracenja bolesnica je u dobrom stanju i nije bilo recidiva krvarenja. A life-threatening case is described here with massive bleeding in a 40-year-old female patient with Crohn's disease. The diagnosis is given through MSCT-angiography and coloileoscopy. Bleeding stopped spontaneously. Through a three-year follow up the patient is in a ood state and with no bleeding recurrence. General hospital Zadar 2009-06-01 text pdf http://hrcak.srce.hr/37774 http://hrcak.srce.hr/file/59362 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.39 No.1-2; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:37777 2009-06-10 journal:31

Atipični karcinoid grkljana - prikaz slučaja Atypical carcinoid of the larynx - case report Grabovac, Stjepan; General Hospital Bjelovar, Department for otorhinolaryngology, Bjelovar, Croatia; stjepan.grabovac@bj.t-com.hr grkljan; atipični karcinoid; liječenje larynx; atypical carcinoid; medical treatment Neuroendokrini karcinomi izuzetno su rijetki u podrucju grkljana, a sukladno preporuci Svjetske zdravstvene organizacije podijeljeni su u tri grupe: tipicni karcinoid – dobrodiferencirani neuroendokrini karcinom, atipicni karcinoid – umjereno diferencirani neuroendokrini karcinom i sitno stanicni neuroendokrini karcinom – slabo iferencirani neuroendokrini karcinom. Važno je razlikovati svaki od ovih tumora zbog drugacijeg nacina lijecenja i prognoze. Atipicni karcinoid je najcešci oblik ove vrste tumora u grkljanu. U pravilu je supragloticne lokalizacije s tendecijom lokalne invazije i metastaziranja. Autori prikazuju slucaj atipicnog karcinoida lokaliziranog na lijevom ariepigloticnom naboru kod 71- godišnjeg muškarca, patohistološku i imunohistokemijsku obradu: citokeratin, epitelijalni membranski antigen, kromogranin A i sinaptofizin. Tretman je ukljucio transoralnu endoskopsku reskeciju tumora. Pacijent je nakon petogodišnjeg pracenja urednog lokalnog nalaza. Neuroendocrine carcinomas are very rare in the area of the larynx, and, according to the World Health Organisation, they are divided into three groups: typical carcinoid – well differentiated euroendocrine carcinoma, atypical carcinoid tumour – moderately differentiated neuroendocrine carcinoma, and a small cell neuroendocrine arcinoma – poorly differentiated neuroendocrine carcinoma. It is very important to differ the mentioned types of tumours because of different types of treatment and prognoses. The atypical carcinoid is the most common type of the larynx tumours and, as a rule, it is supraglottis located with a tendency to local invasion and metastases. The authors show a case of atypical carcinoid localised on the left ryepiglottic fold of a 71-year-old male, pathohistological and mmunohistochemical diagnostic analysis: cytokeratin, epithelial embrane antigen, chromogranin A, synaptophysin. The treatment includes transoral endoscopic resection of the tumour. The patient has been observed for five years and his findings are normal. General hospital Zadar 2009-06-01 text pdf http://hrcak.srce.hr/37777 http://hrcak.srce.hr/file/59368 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.39 No.1-2; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:37780 2009-06-10 journal:31

Hereditarna hemoragijska teleangiektazija (Syndroma Rendu-Osler-Weber) kao uzrok krvarenja iz želuca - prikaz bolesnika Hereditary hemorrhagic teleangiectasis (Rendu-Osler-Weber Syndrome) as cause for stomach hemmorrhage - case report Glumpak, Zvonimir; General Hospital Zabok, Department for internal medicine, Zabok, Croatia Mihaldinec, Zlatko; General Hospital Zabok, Department for internal medicine, Zabok, Croatia Dominiković, Anto; General Hospital Zabok, Department for internal medicine, Zabok, Croatia angiodisplazija; krvarenje; anemija, hematokrit; endoskopija; terapija laserom; argon plazma koagulacija angiodysplasia; bleeding; aenemia; hematocrite; endoscopy; laser therapy; argon plasma coagulation U radu je prikazan sedamdesetcetverogodišnji bolesnik s krvarenjem iz probavnog trakta i posljedicnom sideropenicnom anemijom vjetovanom Rendu-Osler-Weber-ovom bolešcu. Gastroskopski je verificirano oskudno krvarenje iz angiodisplazija u želucu koje se smirilo, vjerojatno spontano. U terapiji je dobivao blokatore protonske pumpe. This paper shows a 74-year-old patient with gastrointestinal bleeding and sideropenic anaemia as consequence of Rendu-Osler-Weber illness. The patient was gastroendoscopically positive on bleeding from angiodysplasias in the stomach. Bleeding stopped most robably spontaneously. The patient was treated with proton pump inhibitors. General hospital Zadar 2009-06-01 text pdf http://hrcak.srce.hr/37780 http://hrcak.srce.hr/file/59374 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.39 No.1-2; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:37783 2009-06-10 journal:31

Tomislav Krpina, dr.med. (1939.-2008.) Mrđen, Anamarija; General Hospital Zadar, Department for neurology General hospital Zadar 2009-06-01 text pdf http://hrcak.srce.hr/37783 http://hrcak.srce.hr/file/59380 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.39 No.1-2; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:41963 2009-10-28 journal:31

Uz 40-tu obljetnicu tiskanja Medicae Jadertinae Vukelić-Baturić, Tatjana; Glavna i odgovorna urednica General hospital Zadar 2009-10-28 text pdf http://hrcak.srce.hr/41963 http://hrcak.srce.hr/file/65793 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.39 No.3-4; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:41964 2009-10-28 journal:31

Invazivne i neinvazivne tehnike uspostavljanja dišnog puta Invasive and noninvasive tehnique in airway management Skitarelić, Nataša; General Hospital Zadar, Department of pediatry Šimurina, Tatjana; General Hospital zadar, Department of anesthesiology and intensive care medicine dišni put; metode reanimacije; algoritam airway; reanimation methods; algorithm Djeca i odrasli bolesnici s opstrukcijom gornjih dišnih putova ili nemogucnošcu disanja, predstavljaju izazov u svakodnevnom radu pedijatra, anesteziologa i otorinolaringologa. Ovakve situacije, do kojih mogu dovesti razliciti uzroci, predstavljaju po život opasna stanja. Najcešce se radi o: gubitku svijesti, posljedici traume, koja je nerijetko pracena obilnim krvarenjem, nazocnosti tumora u gornjim dišnim putovima, alergijskoj reakciji ili prisustvu stranoga tijela u gornjim dišnim putovima. Osim navedenoga, smetnje ventilacije bolesnika mogu nastati i tijekom uvodenja bolesnika u opcu anesteziju, zbog otežane ili nemoguce intubacije bolesnika. Uz invazivne tehnike, kao što su konikotomija i traheotomija, koje se koriste kod ugroženih bolesnika za kontrolu dišnoga puta, danas nam stoje na raspolaganju i razne neinvazivne tehnike. Uz korištenje endotrahealne intubacije i asistirane ventilacije, u takvim slucajevima mogu se koristiti: laringealna maska, ezofagotrahealni tubus i laringoskop za prednju komisuru grkljana s gumenom bužijom. Preporuceni slijed postupaka, može nam poslužiti kao dobar vodic u zbrinjavanju ugroženih bolesnika. Child and adult patients with upper airway obstruction or breathing impossibility represent a challenge in the daily work of a paediatrician, anaesthesiologist and otorhinolaryngologist. Such situations represent life threatening states. There are various causes to such states. Most often we deal with loss of consciousness, trauma consequences often accompanied by abundant bleeding, tumour presence in the upper airway, allergy reaction or foreign body presence in the upper airway. Besides the here mentioned, patient ventilation disorders can occur during general anaesthesia performance due to difficult or impossible patient intubation. Besides invasive techniques such as conicotomy and tracheotomy, which are applied with threatened patients in airway examination, today we also have at our disposal various non-invasive techniques. In such cases, besides the use of endotraecheal intubation and assisted ventilation, the laryngeal mask can be used, esophagotracheal tubus and laryngoscope for the front throat commissure with rubber bougie. The recommended sequence of procedures can be used as a good guideline in threatened patient management. General hospital Zadar 2009-10-28 text pdf http://hrcak.srce.hr/41964 http://hrcak.srce.hr/file/65794 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.39 No.3-4; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:41965 2009-10-28 journal:31

Korelacija vrijednosti inicijalne vidne oštrine i vidnih evociranih potencijala kod bolesnika s optičkim neuritisom sa znakovima demijenilizacije i bez njih Correlation values of initial visual acuity and visual evoked potentials in patients with optic neuritis with or without demyelination Galetović, Davor; Clinical Hospital Center Split, Eye clinic; davorgaletovic@hotmail.com optički neuritis; multipla skleroza; vidna oštrina; vidni evocirani potencijali; incidencija; Hrvatska optic neuritis; multiple sclerosis; visual acuity; visual evoked potentials; incidence; Croatia Idiopatski opticki neuritis predstavlja idopatsku upalu vidnoga živca koja se može razviti odvojeno ili u kontekstu rasprostranjene demijelinizirajuce bolesti. Dijagnoza klinicki definirane multiple skleroze zahtjeva najmanje dvije odvojene epizode neurološke simptomatologije, kao i dvije anatomski i vremenski odvojene lezije demijelinizacije. Zbog toga je magnetska rezonanca mozga najznacajniji cimbenik kod donošenja dijagnoze multiple skleroze. Cilj rada bio je utvrditi povezanost inicijalne vidne oštrine i vrijednosti vidnih evociranih potencijala (VEP) kod bolesnika s klinickim nalazom optickog neuritisa (ON) sa simptomima demijelinizacije i bez njih, te evaluacija terapije i prognoze u smislu povecanog rizika za nastanak multiple skleroze. U ovu smo retrospektivnu studiju ukljucili 56 bolesnika hospitalizarnih na Klinici za ocne bolesti KBC Split u razdoblju od 1. sijecnja 2004. do 31. prosinca 2007. godine. Kriterij za ukljucivanje je bila klinicka slika akutnog optickog neuritisa. Vidna oštrina ispitivana je pomocu Snellenovih optotipa. Medu ostalim pretragama izvršeno je snimanje vidnih evociranih potencijala (VEP) i magnetne rezonance (MR) mozga. Incidencija optickog neuritisa na našoj Klinici iznosila je za ispitivano razdoblje 2,8/100000. Inicijalna vidna oštrina iznosila je od osjeta svjetla i projekcije do l,0, a srednja vrijednost iznosila je 0,32. Vrijednosti latencije VEP-a kretale su se od 82-164 ms, a srednja vrijednost iznosila je 126,82 ms. Pozitivan nalaz MR mozga u smislu demijelinizacije ustanovljen je kod 34 bolesnika (61,7%). Nadena je statisticki znacajna razlika u vrijednostima latencije VEP-a izmedu pacijenata s pozitivnim nalazom MR mozga i onih s urednim nalazom (Mann-Whitney U test, Z = 3,062, p = 0,002), dok postoji razlika u vrijednostima inicijalne vidne oštrine u istim dvjema grupama pacijenata, ali nije statisticki znacajna (Mann-Whitney U test, Z = -1,124, p = 0,261). Rezultati ove studije upucuju na znacajno vecu ucestalost težih oblika optickog neuritisa kod bolesnika s demijelinizirajucim promjenama na mozgu u odnosu na one s urednim MR nalazom mozga, koji se ocituju u smanjenoj vidnoj oštrini i znacajno produženoj VEP latenciji tih ispitanika, te se u kontekstu ovih ispitivanja može raspravljati o prognostickom segmentu rizika nastanka klinicki definirane multiple skleroze (CDMS). Ujedno se na osnovi ovih rezultata može uspješnije modulirati buduca terapija, narocito u svjetlu aktualizacije promptne primjene imunomodulatora u cilju prolongiranja nastanka CDMS. Idiopathic optic neuritis is an idiopathic optic nerve inflammation which can develop separately or together with disseminated demyelizing disease. The diagnosis of clinically defined multiple sclerosis demands at least two separate episodes of neurological symptoms and two anatomically and time separated demyelination lesions. That is the reason why brain magnetic resonance is one of the most important factors for multiple sclerosis diagnosis. The aim of this study was to determine the correlation between initial visual acuity and visual evoked potentials in patients with and without positive findings on brain magnet resonance, and to evaluate the therapy and prognosis of an elevated risk of developing multiple sclerosis. This retrospective study included 56 patients hospitalized in the Department of Ophthalmology between 1st January 2004 and 31st December 2007. The criterion needed to be included was the presence of acute optic neuritis. Visual acuity was determined with Snellen optotypes. Among other clinical testing, we performed visual evoked potential recording and brain magnet resonance. The incidence of optic neuritis in our department was 2,8/100000 inhabitants. Initial visual acuity ranged from light perception to 1,0, and the mean value was 0,32. Visual evoked potential latencies ranged from 82 to 164 ms, and the mean value was 126,82 ms. Positive brain magnet resonance findings for demielination were found in 34 (61.7%) of patients. Statistically significant difference in visual evoked potential latencies was found among patients with positive and negative brain magnet resonance findings (Mann-Whitney U test, Z = 3,062, p = 0,002), while there was a difference in initial visual acuity in the same groups, but it was not statistically significant (Mann-Whitney U test, Z = -1.124, p = 0.261). The results of this study indicate that the incidence of more severe optic neuritis is greater in patients with brain demyelinating lesions than in those with normal brain MR findings, which have lowered visual acuity and significantly prolonged VEP latencies. In the contest of this study, we can appraise the prognostic value and the risk of developing clinically defined multiple sclerosis (CDMS). According to these results, future therapy can be adjusted with more success, especially today when prompt immunomodulatory therapy is being proposed with the goal of prolonging the development of CDMS. General hospital Zadar 2009-10-28 text pdf http://hrcak.srce.hr/41965 http://hrcak.srce.hr/file/65796 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.39 No.3-4; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:41966 2009-10-28 journal:31

Trendovi u epidemiologiji dermatomikoza na karlovačkom području u razdoblju 1995.-2006. Trends in dermatomycoses epidemiology in the Karlovac area from 1995-2006 Cvitanović, Hrvoje; General Hospital Karlovac, Department of dermatology and venerology; hrvoje.cvitanovic@bolnica-karlovac.hr Knežević, Eva; General Hospital Karlovac, Department for dermatology and venerology Kuljanac, Ilko; Opća bolnica Karlovac, Služba za kožne i spolne bolesti, (mr.sc. Ilko Kuljanac, dr.med.) epidemiologija; mikoze; Karlovac epidemiology; mycoses; Karlovac Cilj istraživanja bio je utvrditi ucestalost dermatomikoza u promatranim razdobljima s posebnim osvrtom na moguce promjene s obzirom na spol, lokalizaciju i uzrocnika. Retrospektivnom studijom je ukupno obuhvaceno 148.978 bolesnika od 1995. do 2006., od kojih je 1674 bilo klinicki suspektno na dermatomikozu. Analizirana je ucestalost mikoza za vrijeme dva razdoblja: prvog, neposredno nakon Domovinskog rata 1995.-2000. godine i drugog 2001.-2006. godine. U prvom razdoblju bilo je pozitivno 263 (0,43%) bolesnika, od ukupnog broja 60.571 bolesnika, a u drugom razdoblju 301 (0,34%) od 88.407 bolesnika. Ucestalost na 100.000 stanovnika za prvo razdoblje bila je 185,49, a za drugo razdoblje 212,29. Ta razlika nije bila statisticki signifikantna. Što se tice etiologije, usporedili smo Trichophyton mentagrophytes, cija je ucestalost na 100.000 stanovnika u prvom razdoblju bila 81,11, a u drugom 95,21. Kod Microsporum canis je ucestalost na 100.000 stanovnika u prvom razdoblju bila 49,37, a u drugom 66,29. Ucestalost na 100.000 stanovnika kod Candida spp. je u prvom razdoblju bila 38,05, a u drugom 42,25. Razlike nisu bile statisticki znacajne. U zakljucku isticemo stacionarno stanje u ucestalosti dermatomikoza na našem podrucju. Nema znacajne promjene u vrsti uzrocnika, te postoje promjene u lokalizaciji mikoza u promatranim razdobljima. The aim of our investigation was to compare incidences of dermatomycoses in two periods. The first period was immediately after the war (1995-2000) and the second was the later period (2001-2006). This was a retrospective study carried out in Karlovac General Hospital from 1995-2006 with 1,674 patient clinically suspected for mycosis. In the period immediately after the war, out of a total number of 60,571 patients positive results were obtained in 263 (0.43%), while in the later period, out of a total number of 88,407 patients 301 (0.34%) were positive. The incidence on 100,000 inhabitants was in the first period 185.49, and in the second period 212.29. This difference was not statistically significant. The difference according to gender and period was also not statistically significant. The incidence on 100,000 inhabitants of Trichophyton mentagrophytes in the first period was 81.11, in the second period 95.21. Microsporum canis incidence was 49.37 in the first period and 66.29 in the second period. The incidence of Canida spp. in the period immediately after the war was 38.05 and in later period it was 42.25.There were no statistically significant differences in neither of these species according to periods. In the conclusion we emphasize that there were no changes in incidence of dermatomycoses in our area, there were no significant changes in the causative species but there were changes in the mycoses localization during the observed periods. General hospital Zadar 2009-10-28 text pdf http://hrcak.srce.hr/41966 http://hrcak.srce.hr/file/65798 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.39 No.3-4; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:41973 2009-10-28 journal:31

Mastocitoze u djece Mastocytosis in children Kuljiš, Dubravka; Clinical Hospital Center Split, Clinic of pediatry, Clinical department for hematology, oncology, immunology and genetics Čulić, Srđana; Clinical Hospital Center Split, Clinic of pediatry, Clinical department for hematology, oncology, immunology and genetics; srdjana.culic@st.htnet.hr Armanda, Višnja; Clinical Hospital Center Split, Clinic of pediatry, Clinical department for hematology, oncology, immunology and genetics Sršen, Saša; Clical Hospital center Split, Clinic of pediatry, Clinical department for hematology, oncology, immunology and genetics mastocitoza; djeca mastocytosis; children Mastocitoza je rijetka bolest karakterizirana povecanim stvaranjem i nakupljanjem tkivnih mastocita. Klinicka slika ovisi o mjestu nakupljanja mastocita, o degranulaciji mastocita i oslobadanju medijatora. Urtikarija, crveno-smede makule, papule i plakovi mogu se javiti po citavom tijelu, narocito na trupu. Mastocitoza u djecjoj dobi je najcešce benigna bolest prezentirana nakupljanjem mastocita u koži i ne zahtijeva terapijsku intervenciju. Ucestalost mastocitoze u našoj klinickoj patologiji je 0,06%. Analizirali smo simptome i klinicku sliku kod 10 bolesnika, kod kojih je klinicki i patohistološki dokazana mastocitoza. Kod svih 10 bolesnika, osam djecaka i dvije djevojcice, naden je samo kožni oblik bolesti bez zahvacenosti organa ili sistemnih znakova oslobadanja medijatora iz mastocita. Dijagnoza je postavljena u dojenackom razdoblju, a prosjecna dob bila je 3,5 mjeseca (raspon 0-9 mjeseci). Nalaz koštane srži, biokemijske i ultrazvucne pretrage parenhimnih organa bile su uredne. Deset godišnje pracenje naših bolesnika pokazalo je da su simptomi bolesti kod svih bolesnika polako i spontano nestajali, te djeca nisu imala potrebe za lijecenjem. Mastocytosis is a rare disease characterised by overproliferation and accumulation of tissue mast cells. The clinical signs depend on local accumulation of mast cells in different organs and also on the effects of mast cell degranulation and release of mast cell mediators. Mastocytosis in childhood is usually an indolent disease and presented as cutaneous mastocytosis, and does not need therapeutic intervention. Urticaria, reddish-brown macules, papules and plaques may manifest over the whole body especially on the trunk. The frequency of mastocytosis in our internal pathology is 0,06%. We have analysed the symptoms and clinical course in 10 children with mastocytosis. All analyzed patients, 8 boys and 2 girls, had only indolent cutaneous mastocytosis without extracutaneous involvement or systemic release of mast-cell mediators. All of them had clinical and pathohistological evidence of mast cell proliferation. At the time of diagnosis our patients were infants, mean age of 3,5 months (range 0-9 months). The results of bone marrow analysis were normal, the same as the biochemical and ultrasound examination of parenchymal organs. A ten-year followup revelaed that the disease showed slow spontaneous regression and there was no need for therapy. General hospital Zadar 2009-10-28 text pdf http://hrcak.srce.hr/41973 http://hrcak.srce.hr/file/65808 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.39 No.3-4; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:41980 2009-10-28 journal:31

Učestalost pušenja cigareta u bolesnika s različitim oboljenjem larinksa Prevalence of cigarette smoking in patients with various laryngeal diseases Cikojević, Draško; Clinical Hospital Split, Clinic for otorhinolaringology Glunčić, Ivo; Clinical Hospital Center Split, Clinic for otorhinolaryngology Klančnik, Marisa; Clinical Hospital Center Split, Clinic for otorhinolaryngology pušenje; prekanceroze; tumori larinksa cigarette smoking; precancerous lesion; laryngeal tumor Uvod: Pušenje cigareta je važan predominantni faktor u laringealnoj karcinogenezi. Cilj rada je prikazati ucestalost pušenja cigareta kod razlicitih oboljenja larinksa. Metoda rada: U radu smo analizirali ucestalost pušenja u svih bolesnika u kojih je bila indicirana izravna mikrolaringoskopija na ORL odjelu KB Split u razdoblju od dvije godine. Rezultati su prikazani u tablicama, a analizirani su metodom studentovog t-testa i 2 testa. Rezultati: Radom je obuhvacena skupina od 281 bolesnika, koje smo svrstali u tri grupe: grupa 1 – benigne promjene, grupa 2 – prekancerozne promjene, grupa 3 – zlocudni tumori. Vecina bolesnika su dugogodišnji pušaci (82,92%). Najmanje pušaca bilo je u grupi 1 (72,13%), u grupi 2 bilo ih je 81,48%, a najviše u grupi 3 – 97,14%. Postoji statisticki znacajna razlika u ucestalosti pušenja bolesnika sa zlocudnim tumorom larinksa i bolesnika s benignom ili prekanceroznom promjenom (p < 0,01). Zakljucak: Prikazani rezultati jasno ukazuju na povecanu ucestalost oboljenja larinksa u pušaca, ali i znacajnu statisticku razliku o ucestalosti pušenja u bolesnika s benignim promjenama larinksa u odnosu na bolesnike sa zlocudnim tumorom larinksa. Introduction. Cigarette smoking is a major factor of laryngeal carcinogenesis. The aim was to assess the prevalence of the cigarette smoking habit in patients with various laryngeal diseases. Methods. Data on all patients with indications for direct microlaryngoscopy at ENT Department, Split University Hospital Center, during a two-year period were analyzed. Results were processed by student t-test and 2 test and are presented in the tables. Results. The study included 281 patients, divided into three groups as follows: group 1, benign lesions; group 2, precancerous lesions; and group 3, malignant tumors. The majority of patients (82.92%) had a long history of smoking. The proportion of smokers was lowest in group 1 (72.13%), higher in group 2 (81.48%) and the highest in group 3 (97.14%). There was a statistically significant difference in the prevalence of cigarette smoking between patients with malignant laryngeal tumors and those with benign or precancerous lesions (p < 0.01). Conclusion. Study results clearly pointed to the increased prevalence of laryngeal diseases in smokers, with a statistically significant difference between patients with benign laryngeal lesions and those with malignant laryngeal tumors. General hospital Zadar 2009-10-28 text pdf http://hrcak.srce.hr/41980 http://hrcak.srce.hr/file/65817 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.39 No.3-4; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:41989 2009-10-28 journal:31

Rijetki oblik obostrane pneumatocele u 19-mjesečnog djeteta A rare form of bilateral pneumatoceles in a 19-month-old child Raos, Miljenko; Children's Hospital Srebrnjak, Zagreb; miljenko.dr.raos@zg.t-com.hr Marković, Jelica; Childern's Hospital Srebrnjak, Zagreb pneumatocela; dijete pneumatocele; child Pneumatocele su oštro ogranicene šupljine u plucima ispunjene zrakom, a najcešce su posljedica preboljele bakterijske upale pluca, tupe traume prsnoga koša ili aspiracije ugljikovodika. Prikazuje se 19- mjesecno muško dijete s rijetkom radiološkom slikom obostrane pneumatocele, smještene u superiornim segmentima oba donja plucna režnja (slika naocala). Desna pneumatocela spontano se povukla nakon tri mjeseca, a lijeva nakon osamnaest mjeseci od pocetka bolesti. Pneumatoceles are thin-walled, air-filled cysts within the lung. Most often they are a consequence of sequela to bacterial lung inflammation, blunt chest trauma or hydrocarbon aspiration. A 19- month-old male child is shown here with rare X-ray of pneumatoceles on both sides and located in the superior segments of both lower lobes (eyeglasses picture ). The pneumatoceles on the right side resolved spontaneously after three months, while on the left side after eighteen months from the beginning of the disease. General hospital Zadar 2009-10-28 text pdf http://hrcak.srce.hr/41989 http://hrcak.srce.hr/file/65828 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.39 No.3-4; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:41999 2009-10-28 journal:31

Prikaz bolesnika sa sinkronim tumorom rektuma i sigme Patient with synchrone rectal tumour and sigma presentation Glumpak, Zvonimir; General hospital Zabok, Department of internal medicine Mihaldinec, Zlatko; General hospital Zabok, Depertment of internal medicine Dominković, Anto; General hospital Zabok, Department of internal medicine Škrlec, Ivica; General hospital Zabok, Department of internal medicine Budinski, Ninoslav; General hospital Zabok, Department of internal medicine sinkroni tumor rektuma; sigma synchrone rectal tumour; sigma General hospital Zadar 2009-10-28 text pdf http://hrcak.srce.hr/41999 http://hrcak.srce.hr/file/65839 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.39 No.3-4; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:42001 2009-10-28 journal:31

Razvoj modernog zdravstva otoka Hvara; Biser hrvatskog pisma i etnomedicine Jamnicki Dojmi, Mirko; Medical school "Ante Kuzmanić", Zadar General hospital Zadar 2009-10-28 text pdf http://hrcak.srce.hr/42001 http://hrcak.srce.hr/file/65843 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.39 No.3-4; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:57595 2010-08-19 journal:31

Prisutnost i širenje azijskog tigrastog komarca Stegomyia Albopicta (Aedes albopictus) zapadnom obalom i unutrašnjošću Istre Presence and spreading of the Asian Tiger Mosquito Stegomyia albopicta (Aedes albopictus) along the western coast and the Istrian inland Ferenčić, Nenad; Eko service, Pazin Racz, Aleksandar; Health university Zagreb; aleksandar.racz@zvu.hr Entomologija, komarac, suzbijanje komaraca, tigrasti komarac, suzbijanje komaraca, tigrasti azijski komarac, Aedes albopictus entomology, mosquitoes, mosquito control, Asian Tiger Mosquito, Aedes albopictus Cilj ovoga rada bio je utvrditi aktualnu prisutnost komaraca vrste Stegomyia albopicta u naseljima na zapadnoj obali Istre (Rovinj, Poreč) i utvrditi možebitnu proširenost u unutrašnjosti poluotoka (Pazin). Monitoring je proveden postavljanjem umjetnih legla (ovipozicijskih lovki) na 32 lokacije u gradovima Poreču i Rovinju u kojima je od ranije bila evidentirana prisutnost Stegomyia albopicta, te na 16 lokacija na području Pazina, gdje dosad još nije bio zabilježen. Ukupno je kroz 5 promatranih mjeseci (lipanj, srpanj, kolovoz, rujan i listopad 2008.) postavljeno po 80 ovipozicijskih lovki mjesečno, ukupno njih 400. Na području Rovinja kod 30% lovki pronađen je pozitivan nalaz u rasponu od 21,9% - 37,5%. Od 48 pozitivnih nalaza, kod čak 21 lovke (42,3%) pozitivan nalaz zabilježen je po prvi put. Na području Poreča kod 26,9% lovki pronađen je pozitivan nalaz u rasponu od 15,6% - 34,4%. Od 43 pozitivna nalaza na toj lokaciji, kod čak 19 lovki (42,5%) pozitivan nalaz zabilježen je po prvi put, što jasno govori u prilog ustaljivanju komarca na već ranije poznatoj lokaciji, ali i istiskivanja drugih vrsta komaraca s domicilnog područja. Na području grada Pazina po prvi puta je tako duboko u unutrašnjosti Istre utvrđen pozitivan nalaz i to kod 4 lovke (5%). Širenje vrste ukazuje na nedovoljnu učinkovitost dosad poduzimanih mjera, te prednost u suzbijanju ove vrste komaraca treba dati profesionalnim izvoditeljima mjera dezinsekcije s područja Istre, jer je u suzbijanju vrste neophodna koordinirana i trajna svakodnevna prisutnost izvoditelja na terenu. The aim of this paper was to check the presence of the Stegomyia albopicta mosquito in towns on the western Istrian coast (Rovinj, Poreč) and to detect the possible spreading towards the Istrian peninsula inland (Pazin). Monitoring was carried out by setting artificial nests (ovitraps) on 32 locations both in the towns of Poreč and Rovinj, where the presence of Stegomyia albopicta has already been recorded, as well as on 16 locations in the Pazin area, where the mosquito has not been recorded yet. During 5 months of monitoring (June, July, August, September and October of 2008) the total of 80 ovitraps were set up every month, which adds up to 400 traps in the aforementioned three towns. In the Rovinj area 30% of traps showed a positive finding in a range of 21.9% - 37.5 %. Out of 48 positive findings, as much as 21 traps (42.3%) showed positive finding for the first time. In the Poreč area 26.9% of traps showed positive finding in a range of 15.6% - 34.4%. Out of 43 positive results, positive finding on that location was recorded in as much as 19 traps (42.5%), which clearly supports both the settling of mosquitoes on the already known location, and the displacing of other mosquito types from their domicile area. The case of 4 traps (5%) in the Town of Pazin area was the first positive finding recorded so deep in the Istrian inland. T e spreading of the species indicates the insufficiency of measures undertaken so far, thus the priority in fighting this mosquito should be given to professional disinfectors in Istria, since the fighting of this species requires a coordinated and permanent everyday presence of field disinfectors. General hospital Zadar 2010-08-19 text pdf http://hrcak.srce.hr/57595 http://hrcak.srce.hr/file/87276 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.40 No.1-2; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:57599 2010-08-19 journal:31

Sigurnost primjene atorvastatina sa stanovišta genotoksičnosti Atorvastatin therapy safety from the aspect of genotoxicity Gajski, Goran; Institut za medicinska istraživanja i medicinu rada, Jedinica za mutagenezu, Zagreb Garaj-Vrhovac, Vera; Institut za medicinska istraživanja i medicinu rada, Jedinica za mutagenezu, Zagreb; vgaraj@imi.hr statini, atorvastatin, kolesterol, terapija, nuspojave statins, atovarstatin, cholesterol, therapy, adverse effects Primjena statina danas predstavlja jedan od osnovnih pristupa u liječenju bolesti koje su vezane uz povišenu razinu kolesterola u krvi. Osnovni cilj djelovanja ove skupine lijekova usmjeren je prema snižavanju ukupne koncentracije kolesterola u krvi inhibicijom djelovanja 3-hidroksi-3-metilglutaril koenzim A (HMG-CoA) reduktaze. Da bi se postigao što bolji terapijski učinak u što kraćem vremenskom razdoblju, primjenjuju se različite koncentracije ovih lijekova u rasponu od 10 mg/dan do 80 mg/dan. Rezultati dosadašnjih epidemioloških istraživanja pokazali su da određene koncentracije ovih lijekova mogu ostaviti posljedice na okolne stanice i tkiva nakon dulje izloženosti, od kojih su najčešće bolesti skeletnih mišića, jetrene bolesti, povećane vrijednosti serumskih transaminaza, te miopatija koja može voditi u rabdomiolizu i bubrežno zatajenje. Istraživanja lijekova koji se koriste za snižavanje razine kolesterola u krvi provode se od njihovog otkrića u ranim sedamdesetim godinama prošloga stoljeća. Iako su se pristupi istraživanjima mijenjali tijekom godina, cilj im je uvijek bio isti – pronaći one najpogodnije te one doze u kojima bi njihova djelotvornost bila najučinkovitija, a rizik od mogućih posljedica najmanji. Ovaj rad stoga donosi pregled dosadašnjih istraživanja vezanih uz sigurnost atorvastatina u terapijske svrhe i smjernice za provođenje protokola za tesiranje lijekova. The application of statin today represents one of the basic approaches to the treatment of the disease connected to high levels of cholesterol in the blood. Statins are a widely used group today found in different generic names of cholesterol-lowering agents that act by inhibiting 3-hydroxy 3-methylglutaryl CoA (HMG CoA) reductase, an enzyme which catalyses the rate-limiting step in cholesterol biosynthesis. In order to achieve the best therapeutical effects in the shortest period of time various concentrations of these drugs are administered in the range of containing 10 mg/day to 80 mg/day atorvastatin. The results of recent epidemiological researches have shown that determined concentrations of these drugs administered over a longer period can have serious side effects. The most important adverse effects in clinical practice are disease of the skeletal muscles, asymptomatic increases in liver transaminases, progressive liver disease and myopathy which can lead to rhabdomyolysis and cause acute renal failure. Researches regarding this group of drugs have been conducted since the early seventies of the last century with the same effort; to find suitable dosage that would be effective in reducing the cholesterol level. Even though the research approaches have changed through the years, the aim has always been the same; to find the most adequate and most effective dosage with the lowest side effect risk. This review paper brings therefore an overview of recent researches regarding atorvastatin therapy safety with guidelines for protocols used in drug research. General hospital Zadar 2010-08-19 text pdf http://hrcak.srce.hr/57599 http://hrcak.srce.hr/file/87284 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.40 No.1-2; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:57608 2010-08-20 journal:31

Anonimni alkoholičari Alcoholics Anonymous Torre, Robert; Klinička bolnica "Sestre milosrdnice", Klinika za psihijatriju, Zagreb, Hrvatska Zoričić, Zoran; Klinička bolnica "Sestre milosrdnice", Klinika za psihijatriju, Zagreb, Hrvatska Katanić, Križo; Klinička bolnica "Sestre milosrdnice", Klinika za psihijatriju, Zagreb, Hrvatska Škifić, Boris; Opća bolnica Zadar, Odjel za psihijatriju Anonimni alkoholičari, oporavak, Bill Wilson, grupe samopomoći po metodi 12 stepenica, povijest Anonimnih alkoholičara Alcoholics Anonymous, recovery, Bill Wilson, 12 steps self-help groups, Alcoholics Anonymous history Anonimni alkoholičari (Alcoholics Anonymous) su daleko najmnogoljudnija, najpoznatija i najučinkovitija organizacija koja se bavi tretmanom ovisnika o alkoholu. Oni su za alkoholičare svijeta učinili više nego svi sustavi tretmana i prevencije alkoholne ovisnosti zajedno, i kao planetarni socijalni pokret oni su pomogli doslovce milijunima alkoholičara. Upravo su Anonimni alkoholičari bili onaj temeljni jezičac na vagi, koji je senzibilizirao stručnu i zainteresiranu javnost da ovisnost o alkoholu počne doživljavati, ne više kao moralni porok, nego isključivo kao bolest, i to kao izlječivu bolest. Teorijski i terapijski konstrukti Anonimnih alkoholičara bili su od krunske vrijednosti stručnim sustavima tretmana ovisnika o alkoholu diljem svijeta i u manje-više modificiranom vidu ugrađeni su u sve sustave pomoći ovisnicima o alkoholu. Štoviše u mnogima od njih je prisustvovanje sastancima grupa Anonimnih alkoholičara obvezni i sastavni dio liječenja. U preglednom članku je elaborirana svjetsko-povijesna specifičnost pokreta Anonimnih alkoholičara, navedeni su najznačajniji trenuci u gotovo osamdeset godina dugoj povijesti Anonimnih alkoholičara, iznesene su njihove aktivnosti, počela rada i doktrina po kojoj se oporavljaju, te brojnost i karakteristike njihovog članstva, kao i aktualna rasprostranjenost grupa Anonimnih alkoholičara diljem svijeta. Alcoholics Anonymous is by far the most numerous, most well-known and most effective organization dealing with alcohol addicts' treatment. The Anonymous have done more for the world alcoholics than all the systems of alcohol addiction treatment and prevention together, and as a planetary social movement, it has literally helped millions of alcoholics. Alcoholics Anonymous have tipped the scales by making the professional and interest public perceive that addiction to alcohol was not to be experienced any more as a moral vice but as a disease, and a disease that could be healed. The theoretical and therapeutic constructions of Alcoholics Anonymous were of vital importance to the expert treatment systems of alcohol dependence throughout the world and have, in a modified aspect, been more or less built into all the alcohol dependence assistance systems. Moreover, in many of these, attendance at Alcoholics Anonymous group meetings is an obligatory and integral part of the treatment. In this review article, the world history specific quality of the Alcoholics Anonymous movement has been elaborated; the most significant moments have been stated in the almost eighty-year-long history of Alcoholics Anonymous; their activities have been brought out, working elements and doctrines by which they recover and the number and characteristics of their membership, as well as the actual diffusion of Alcoholics Anonymous groups throughout the world. General hospital Zadar 2010-08-19 text pdf http://hrcak.srce.hr/57608 http://hrcak.srce.hr/file/87302 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.40 No.1-2; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:57609 2010-08-20 journal:31

Pojavnost i zakonodavna regulacija kockanja The phenomenon and the legislative regulations on gambling Torre, Robert; Klinička bolnica "Sestre milosrdnice", Zagreb, Hrvatska Zoričić, Zoran; Klinička bolnica "Sestre milosrdnice", Zagreb, Hrvatska Škifić, Boris; Opća bolnica Zadar, Odjel za psihijatriju zakonodavna regulacija kockanja, pojavnost patološkog kockanja, profil patoloških kockara legislative regulation of gambling, pathological gambling phenomenon, pathological gamblers profile Djelatnost igara na sreću, kockanja i klađenja u zemljama Europske unije karakteriziraju u pravilu manji ili veći, ali svakako monopolni ili oligopolni sustavi nadzora. Po pitanju regulacije igara na sreću različite zemlje EU imaju različite, prilično neharmonizirane pristupe. Posljednjih petnaestak godina, po zakonodavnoj liberalizaciji od državno-monopolne k tržišnoj regulaciji priređivanja igara na sreću, u Hrvatskoj je vidno eskalirala ponuda, promidžbeni marketing, a time i potražnja igara na sreću, sukladno čemu je značajno porastao i broj ovisnika o igrama na sreću (napose o kockanju i klađenju). Obzirom da je u nas riječ o nedovoljno reguliranom, nezrelom tranzicijskom tržištu igara na sreću u anomičnom društvu, adiktivni potencijal tržišta igara na sreću u nas je izraženiji. Postotak ovisnika o kockanju među pučanstvom veći je u zajednicama s duljom tradicijom kockanja. U državama u kojima je kockanje legalizirano unazad desetak godina, 0,5% pučanstva tvore patološki kockari, a u državama u kojima je kockanje legalizirano već više od dvadeset godina među pučanstvom je do 1,5% patoloških kockara. Socijalni, spolni i dobni profil patoloških kockara u nas, podudara se s onim iz razvijenih zapadnih zemalja: osobe s problemom kockanja u pravilu su zaposleni, mlađi muškarci, sa srednjom stručnom spremom, oženjeni su ili su u ozbiljnim predbračnim vezama, i u pravilu je riječ o osobama s višegodišnjom ovisnošću o klađenju ili kockanju u automat-klubovima. Activity games of chance, gambling and betting in the European Union countries are, as a rule, characterized by small or big, but surely monop listic or oligopolistic, surveillance systems. Concerning the regulation of games of chance, different EU countries have different but quite non-harmonized approaches. In the past fifteen years, according to the legislative liberalization from state monopolistic to market regulation arrangement of games of chance, the offer, marketing material and demand for games of chance have noticeably escalated in Croatia, and, pursuant to this, the number of game of chance addicts (particularly gambling and betting) has also escalated. Since we are here dealing with an insufficiently regulated and immatu e transitional market of games of chance in an anomie society, the addictive potential of the games of chance market in our country is more emphasized. The percentage of gambling addicts among the population is bigger in communities with a longer gambling tradition. In the countries where gambling was legalized ten years ago 0.5% of the population is made up of pathological gamblers, while in countries where gambling was legalized more than ten years ago, 1.5% of the population is made up of pathological gamblers. The social, gender and age profile of pathological gamblers in our country overlaps with the number in developed western countries, they are married or in a serious pre-marital relationship, and, as a rule, they are people with a longstanding addiction to betting or gambling in gambling-machine clubs. General hospital Zadar 2010-08-19 text pdf http://hrcak.srce.hr/57609 http://hrcak.srce.hr/file/87304 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.40 No.1-2; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:57611 2010-08-20 journal:31

Identificiranje i liječenje mentalnih problema adolescenata u primarnoj zdravstvenoj zaštiti Identifying and treating adolescent mental health problems in primary health care Kumbrija, Suzana; Škola narodnog zdravlja "Andrija Štampar", Zagreb, Hrvatska; suzana.kumbrija@zg.htnet.hr Marđetko, Martina; Medicinski fakultet Sveučilišta u Zagrebu, studentica 6. godine Majer, Marjeta; Medicinski fakultet Sveučilišta u Zagrebu, studentica 6. godine Vuković, Hrvoje; Ordinacija opće medicine (Zadar) Blažeković-Milaković, Sanja; Škola narodnog zdravlja "Andrija Štampar", Katedra obiteljske medicine, Medicinski fakultet Sveučilišta u Zagrebu, Hrvatska Stojanović-Špehar, Stanka; Škola narodnog zdravlja"Andrija Štampar", Katedra obiteljske medicine, Zagreb, Hrvatska obiteljska medicina, sveobuhvatna zdravstvena zaštita, adolescent, depresija family medicine, comprehensive health care, adolescent, depression Razdoblje od kasne adolescencije do sredine dvadesetih godina, poznato je kao prijelazno prema odrasloj dobi, a ujedno i rizično razdoblje za razvoj depresije. Uobičajeni simptomi djece i adolescenata koji boluju od depresije su bolovi u trbuhu, glavobolja i umor. Tijekom posjete obiteljskom liječniku, bolesnici često zaboravljaju napomenuti svoje emocionalne probleme što zajedno s liječnikovom nedovoljnom sposobnošću da prepozna skriveni dio u odnosu liječnik-bolesnik, otežava rano postavljanje dijagnoze i otežava intervenciju. Cilj. Rasvijetliti ulogu dobro educiranog obiteljskoga liječnika, kao koordinatora u timskom radu i podijeljenoj zdravstvenoj skrbi u identificiranju i liječenju mentalnih bolesti adolescenata. Metoda. Biopsihosocijalni pristup obiteljskoga liječnika. Rezultati. Prikaz slučaja adolescentne djevojke s mnogobrojnim obiteljskim problemima, koja je oboljela od depresije. Simptomi depresije započeli su prije pet godina manifestirajući se kao somatski poremećaji – bolovi u trbuhu i glavobolje, a kulminirali su višestrukim samoozljeđivanjima po koži u vidu ogrebotina, rana i opekotina. Djevojka je imala cijelu paletu rizičnih predisponirajućih čimbenika za razvoj depresije: majčinu mentalnu bolest, narušene obiteljske odnose, obiteljsko nasilje, malu podršku okoline i lošu suradnju s ostalim članovima obitelji. Obiteljski liječnik, u čijoj su skrbi bili i otac i mlađi brat, pravovremeno je uključio socijalnu službu u rješavanje problema mentalno oboljele nasilne majke, te uputio djevojku na psihijatrijsko liječenje, te provodio trajnu suportivnu psihoterapiju. Zaključak. Uloga dobro educiranog obiteljskog liječnika, kao koordinatora u timskom radu i podijeljenoj zdravstvenoj skrbi, od presudne je važnosti u identificiranju i liječenju mentalnih bolesti adolescenata. The period from late adolescence to the mid twenties, known as transition to grown up age, is a risk period for development depression. Stomach pain, headache and fatigue are common symptoms in children and adolescents suffering from depression. Patients often fail to mention their emotional problems during the family physician’s consultation. Together with the physician’s insufficient ability to recognize the hidden part in the physician-patient relationship, it makes early diagnosis and adequate intervention more difficult. Aim: To enlighten the role of a well-educated family physician as a coordinator in team work and shared medical care in identifying and treating adolescent mental health problems. Method: Family physician’s bio-psychosocial approach. Results: Case report of an adolescent girl who developed depression connected to multiple family environment problems is presented. Problems connected to depression started five years ago. They appeared as somatic troubles, stomach pain and headache. The girl had a whole range of predisposing risk factors for depression, including the mother’s mental illness, deteriorated family relationships, multiple family violence, low support and cooperation with other family members. Conclusion: The role of a well-educated family physician as a coordinator in team work and shared medical care is crucial in identifying and treating adolescent mental health problems. General hospital Zadar 2010-08-19 text pdf http://hrcak.srce.hr/57611 http://hrcak.srce.hr/file/87308 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.40 No.1-2; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:57613 2010-08-20 journal:31

Prikaz trovanja biljnom vrstom žuta rajska ptica (Poinciana gilliesii Hook) Poisoning with plant Yellow Bird of Paradise (Poinciana gillesii Hook) Radman, Darko; Opća bolnica Zadar, Odjel za pedijatriju; darko.radman@zd.t-com.hr trovanje biljkama, Poinciana gillesii, dijete plant poisoning, poinciana gillesii, child Trovanja biljkama kod djece su rijetka. Prikazali smo četvero bolesnika koji su jeli plodove biljke žuta rajska ptica (Poinciana gilliesii). Opisana je klinička slika, laboratorijski nalazi, te tijek bolesti. Dati su osnovni podaci o biljci, te naglašena pomoć ing. hortikulture. Plant poisoning in children is rare. We have reported four patients who eat the fruit of the Yellow Bird of Paradise (Poinciana gilliesii) plant. We described the clinical picture, laboratory date and course of illness. Fundamental information on the plant is given. A botanic specialist participated in recognising the plant. General hospital Zadar 2010-08-19 text pdf http://hrcak.srce.hr/57613 http://hrcak.srce.hr/file/87312 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.40 No.1-2; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:57621 2010-08-23 journal:31

Sekvestracija pluća - Prikaz slučaja Pulmonary sequestration - Case report Raos, Miljenko; Dječja bolnica srebrnjak, Zagreb; miljenko.dr.raos.@zg.t-com.hr Marković, Jelica; Dječja bolnica Srebrnjak, Zagreb sekvestracija pluća; prirođene anomalije pluća; dijete. pulmonary sequestration; inborn pulmonary anomalies; child Sekvestracija pluća rijetka je razvojna plućna anomalija nepoznatog uzroka. Dio plućnog parenhima ne komunicira s traheobronhalnim stablom, te ima anomalnu cirkulaciju. Prikazano je žensko dijete u dobi od dvije god ne sa sekvestracijom pluća lijevo, a prema nalazu MSCT-a, najvjerojatnije se radi o ekstralobarnoj sekvestraciji pluća, međutim nije isključena niti moguća arteriovenska anomalija. Kako je anomalija asimptomatska roditelji nisu pristali na preporučeni operativni zahvat. A pulmonary sequestration is a rare developmental pulmonary anomaly of unknown origin. A segment of pulmonary parenchyma does not communicate with the tracheobronchial tree and has anomalous circulation. A two-year-old female child with leftside pulmonary sequestration is presented. According to the MSCT, it could presumably be a extralobar pulmonary sequestration, although possible arteriovenous anomaly could not be excluded. Since it was an asymptomatic anomaly, the parents did not consent to the recommended surgical procedure. General hospital Zadar 2010-08-19 text pdf http://hrcak.srce.hr/57621 http://hrcak.srce.hr/file/87326 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.40 No.1-2; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:57622 2010-08-23 journal:31

Apsces vrata uzrokovan infekcijom salmonelom - Prikaz slučaja Neck abscess caused by salmonella infection - Case report Shejbal, Dražen; Opća županijska bolnica Pakrac, ORL djelatnost, Pakrac; dr.azen@vip.hr Grgić, Marko; Klinička bolnica "Sestre milosrdnice", Odjel za ORL i kirurgiju vrata, zagreb Trotić, Robert; Klinička bolnica "Sestre milosrdnice", Odjel za ORL i kirurgiju glave i vrata, Zagreb Ries, Mihael; Klinička bolnica "Sestre milosrdnice", Odjel za ORL i kirurgiju glave i vrata, Zagreb salmonela; vrat; apsces salmonella; neck, abscess Rijetke su infekcije salmonelom van gastrointestinalnog područja, a salmonelom uzrokovan apsces vrata još je rjeđi. U svjetskoj literaturi pronašli smo 15 opisanih slučajeva. Svi opisani slučajevi kao predisponirajući čimbenik imali su onkološku bolest ili dijabetes. Prikazan je slučaj 53-godišnje pacijentice s apscesom vrata, u koje je dijabetes bio loše reguliran; samo glibenklamid tabletama. Bolest je počela povišenom temperaturom i oticanjem desne strane vrata, 10 dana prije prijema u bolnicu. Unatoč uzimanju azitromicina, cefalexina i medazola, oteklina je postajala veća, a opće stanje bolesnice sve teže. Bolesnica prije početka bolesti nije imala nikakvih gastrointestinalnih simptoma, povećanih limfnih čvorova ili zubobolje. Apscesna šupljina je ispražnjena, a kultivacijom je gnoj bio pozitivan na Salmonellu enteritidis. Bolesnica je prebrodila kritično razdoblje ordiniranim antibiotskim liječenjem po antibiogramu, pravilnom i intenzivnom njegom rane, te regulacijom šećerne bolesti. Pacijentica je dobrog općeg stanja otpuštena 4 tjedna po hospitalizaciji. Salmonella infections outside the gastrointestinal tract are rare, but abscess of the head and neck caused by salmonella are even more uncommon. There are only 15 focal head and neck abscesses reported in world literature. All the described cases had the predisposed factor of oncological diseases or diabetes. The case of a 53 –year-old female patient is shown, with poorly controlled diabetes mellitus, with occasionally used glibenclamid tablets. The disease started with right sided anterior mass and fever. The mass was first noticed 10 days prior to admission in hospital and became progressively larger and more tender. She used azitromicin, cephalexin and medazol but the neck mass became progressively larger and more tender. She denied having had any previous GI, lymphadenopaty disease or toothache. A CT scan was performed, and after eruption approximately 5 ml of pus was obtained and cultured. After 24 hours, pus cultures were positive for Salmonella enteritidis. No other organisms were recovered. Salmonella was sensitive to amoxicillin+clavulonat and gentamicin, and the therapy with these agents began with parenteral insuline. The patient had overcome the critical period by being treated with antibiotics according to antibiogram, proper and intensive care of lesion and diabetes regulation. The patient was in a good general state and discharged 4 weeks later. General hospital Zadar 2010-08-19 text pdf http://hrcak.srce.hr/57622 http://hrcak.srce.hr/file/87328 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.40 No.1-2; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:57623 2010-08-23 journal:31

Ivo Jajić - Zrinka Jajić: Razvoj reumatologije tijekom dva tisućljeća (hrvatsko izdanje) Dugački, Vladimir General hospital Zadar 2010-08-19 text pdf http://hrcak.srce.hr/57623 http://hrcak.srce.hr/file/87330 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.40 No.1-2; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:65088 2011-03-14 journal:31

Istraživanje okratoksina A u ječmu - doprinos mikotoksinskoj hipotezi nastanka endemske nefropatije Determination of ochratoxin A in barley-Contribution to the mycotoxin hypothesis on the etiology of endemic nephropaty Pavlinić, Iva; Institut za zaštitu bilja, Zagreb Puntarić, Dinko; Zavod za javno zdravstvo "Dr. A.Štampar",Zagreb,Služba za zdravstvenu ekologiju; dinko.puntaric@stampar.hr Bošnir, Jasna; Zavod za javno zdravstvo "Dr.Andrija Štampar",Zagreb,Služba za zdravstvenu ekologiju Lasić, Dario; Zavod za javno zdravstvo,Zagreb,Služba za zdravstvenu ekologiju Barušić, Lidija; Zavod za javno zdravstvo "Dr.Andrija Štampar",Zagreb,Služba za zdravstvenu ekologiju Jergović, Matijana; Zavod za javno zdravstvo "Dr.Andrija Štampar", Zagreb,Služba za zdravstvenu ekologiju Miškulin, Maja; Sveučilište J.J.Strossmayera u Osijeku, Medicinski fakultet Osijek Puntarić, Ida; Medicinski fakultet Zagreb Vučić, Katarina; Hrvatski zavod za zdravstveno osiguranje Zagreb mikotoksini; okratoksin A; endemska nefropatija; žitarice; ječam; Hrvatska mycotoxins; ochratoxin A; endemic nephropaty; cereals; barley, Croatia Cilj istraživanja bio je utvrditi koncentracije okratoksina A (OTA) u ječmu iz okolice Slavonskog Broda, područja pojavljivanja Balkanske endemske nefropatije (BEN), te ih usporediti s koncentracijama u ječmu iz „neendemskih“ Osijeka i Nove Gradiške. Tankoslojna kromatografija (TLC) i visokotlačna tekućinska kromatografija (HPLC) bile su korištene za detekciju okratoksina A u uzorcima ječma skupljenim tijekom 2000. i 2002. godine. Maksimalno dozvoljena koncentracija (MDK) okratoksina A u žitaricama je 5 μg/kg. Najviše koncentracije OTA (medijan 25 μg/kg; interval pouzdanosti 20,0-25,0 μg/kg) utvrđene su u ječmu iz Slavonskoga Broda iz 2000. godine, potom u ječmu iz istog područja prikupljenom 2002. godine (medijan 20 μg/kg; interval pouzdanosti 10,0-20,0 μg/kg; p < 0,001). U uzorcima ječma iz Osijeka prosječna koncentracija OTA u uzorcima iz 2000. godine iznosila je 12,5 μg/kg (medijan 12,5 μg/kg; interval pouzdanosti 10,0-20,0 μg/kg), dok niti u jednom uzorku iz 2002. godine, kao i u uzorcima iz Nove Gradiške nije utvrđen OTA. Utvrđena je statistički značajno veća koncentracija OTA u uzorcima sakupljenim 2000. godine u Slavonskom Brodu i Osijeku od onih iz 2002. godine. Uspoređujući međusobno uzorke prema lokaciji uzorkovanja utvrđena je statistički značajna razlika uzoraka iz Slavonskog Broda u odnosu na „neendemska područja“. Vlaga zrna niti u jednom uzorku nije prelazila dozvoljenih 14%. Kontaminacija ječma OTA značajno je viša u okolici Slavonskoga Broda u odnosu na ostala ispitivana područja, te višestruko prelazi dozvoljene koncentracije što govori o mogućoj povezanosti BEN i kontaminacije žitarica OTA i općenito mikotoksinima. The aim of the study was to determine ochratoxin A (OTA) concentration in barley from the Slavonski Brod area endemic for the Balkan endemic nephropathy (BEN) in comparison with barley from Osijek and Nova Gradiška areas free from BEN. Thin-layered chromatography and high-performance liquid chromatography were used on OTA detection in barley samples collected in 2000 and 2002 at Slavonski Brod, Osijek and Nova Gradiška locations. Considering the maximum allowable concentration (MAC) of 5 μg/kg for cereals, the highest OTA concentrations were determined in barley samples collected in the Slavonski Brod area in 2000 (median 25 μg/kg; confidence interval 20.0 – 25.0 μg/kg), followed by barley samples collected in the same area in 2002 (median 20 μg/kg; confidence interval 10.0 – 20.0 μg/kg) (p < 0.001). In the Osijek area, the median OTA concentration in barley samples from 2000 was 12.5 μg/kg (confidence interval 10.0 – 20.0 μg/kg), whereas barley samples collected in 2002 were free from OTA as were those collected in both 2000 and 2002 in the Nova Gradiška area. Comparison of barley samples in separate Slavonski Brod and Osijek areas yielded statistically significant differences in OTA concentration between the samples collected in 2000 and 2002. Mutual comparison of samples according to the sampling locations established a statistically significant difference between the samples collected in the Slavonski Brod area and those from non-endemic areas in 2000 and 2002. Grain humidity did not exceed the allowable level of 14% in any of study samples. In the Slavonski Brod area, barley contamination with OTA exceeded MAC several fold and was significantly higher in the Slavonski Brod area than in other study areas which suggests the possible connection between BEN and OTA contamination of cereals and mycotoxins in general. General hospital Zadar 2011-03-01 text pdf http://hrcak.srce.hr/65088 http://hrcak.srce.hr/file/97468 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.40 No.3-4; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:65090 2011-03-14 journal:31

Raširenost dirofilarioze na području unutrašnjosti istarskoga poluotoka The prevalence of dirofilariasis in the hinterland of the Istrian peninsula Holler, Dražen; Veterinarska stanica Buzet Racz, Aleksandar; Zdravstveno veleučilište Zagreb; aleksandar.racz@zvu.hr Bošnir, Jasna; Zavod za javno zdravstvo "Dr. Andrija Štampar", Zagreb Petrak, Olivera; Zdravstveno veleučilište Zagreb dirofilarioza; Dirofilaria immitis; zoonoze; vektorski prenošene bolesti; Knott test; mikrofilarijaza dirofilariasis; Dirofilaria immitis; zoonoses; reservoir disease; disease vectors, Knott test, microfilariasis Istra je uz Dubrovačko-neretvansku županiju jedno od dva područja u Hrvatskoj u kojima je nedvojbeno utvrđena prisutnost dirofilarioze pasa uzrokovane parazitom Dirofilaria immitis. Nasuprot tome, dirofilarioza uzrokovana parazitom Dirofilaria repens u pasa je prisutna širom Hrvatske. U razdoblju od prvog utvrđenog slučaja humane dirofilarioze istim uzročnikom 1996. godine do danas dokumentirano je preko desetak oboljelih osoba. S obzirom da je komarac iz roda Aedes albopictus, koji se unazad tri godine agresivno širi uz obale istarskoga poluotoka i prema unutrašnjosti, upravo vektor koji dirofilarijazu prenosi s pasa kao prirodnih domaćina, na druge životinje i čovjeka, željela se istražiti epizootiološka raširenost dirofilarijaze među psima na području Buzeštine. Istraživanjem je bilo obuhvaćeno 200 pasa, što predstavlja 10%-tni uzorak ukupnoga broja registriranih pasa na području epizootiološke jedinice Buzet. Metodom Knott testa i testom IDEXX SNAP 4Dx bolest je potvrđena kod 61 (30,5%) psa. Među njima mikroskopskom diferencijacijom je kod 45,9% pozitivnih nalaza identificirana Dirofilaria repens, a kod još 26,3% njih vrlo vjerojatno se radilo o parazitu Dirofilaria repens. U 6,6% pozitivnih slučajeva se sigurno, a u daljnjih 9,8% vjerojatno radilo o Dirofilaria immitis, pri čemu je utvrđena i statistički značajno veća prisutnost Dirofilariae repens. (χ2 = 17,02; df = 1; p < 0,01). Nije međutim utvrđena statistički značajna razlika u obolijevanju pasa s obzirom na spol (χ2 = 0,258; df = 1; p > 0,05), kao ni u učestalosti obolijevanja između psa tartufara i lovačkih pasa. Lociranjem pozitivnih nalaza na geografskoj karti jasno se izdvajaju posebno ugrožena područja i to u neposrednoj blizini Butoniga jezera i toka rijeke Mirne, te njezinih pritoka, dok je bolest zbog klimatogeografski nepovoljnijih uvjeta za razmnožavanje komaraca rjeđa na području Ćićarije, Erkovčića i sjevera općine Buzet. Posebno je zabrinjavajuće što je t-testom za proporcije na području Istre statistički potvrđena prisutnost značajno više oboljelih pasa nego u istraživanju provedenom na tom području prije tri godine (t = 3,41). Istria, along with the Dubrovnik-Neretva County, is one of the two regions in Croatia where the presence of dirofilariasis in dogs caused by the parasite Dirofilaria immitis has been positively confirmed. On the other hand, dirofilariasis in dogs caused by the parasite Dirofilaria repens is present throughout Croatia. Over ten human cases have been recorded in the period after the first confirmed case of dirofilariasis in man caused by the same parasite in 1996 to the present day. Considering the fact that the mosquito of the Aedes albopictus genus, which has been spreading aggressively along the coasts of the Istrian peninsula and towards its hinterland for the past three years, is the vector that transmits dirofilariasis from dogs, its natural hosts, to other animals and man, we would like to investigate the epizootiological prevalence of dirofilariasis among dogs in the area of Buzeština. Studies were carried out on 200 dogs, representing a 10% sample of the total number of dogs registered in the area of the Buzet epizootiological unit. The disease was confirmed in 61 (30.5%) dogs by Knott test and IDEXX SNAP 4Dx test. In 45.9% of these cases Dirofilaria repens was identified by microscopic differentiation of positive findings, and in the other 26.3% of cases the presence of the parasite Dirofilaria repens was deemed very probable. It was considered certain that Dirofilaria immitis was the causative agent in 6.6% of positive cases, and probably in further 9.8% of cases, confirming thereby statistically a significantly higher presence of Dirofilaria repens (χ2 = 17.02; df = 1; p < 0.01), as well. However, no statistically significant difference in the prevalence of the disease has been established with respect to the gender of dogs (χ2 = 0.258; df = 1; p > 0.05) nor with respect to the prevalence of the disease between truffle dogs and hunting dogs. When locating positive findings on the geographical map, the endangered areas are clearly discernible, especially in the immediate vicinity of Lake Butoniga and the Mirna River with its tributaries. However, due to less favourable climatic and geographical conditions for the reproduction of mosquitoes, the disease is less frequent in the Ćićarija, Erkovčić area and in the northern part of the municipality of Buzet. It is very worrying that t-test for proportions in the area of Istria have statistically confirmed the presence of a significantly greater number of affected dogs compared to the investigation carried out in the same area three years ago (t = 3.41). General hospital Zadar 2011-03-01 text pdf http://hrcak.srce.hr/65090 http://hrcak.srce.hr/file/97472 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.40 No.3-4; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:65091 2011-03-14 journal:31

Uloga sanitarno-inspekcijskog nadzora vode u osiguranju javnozdravstvene zaštite u Republici Hrvatskoj The role of sanitary inspection of water in public health protection in Croatia Vitale, Ksenija; Škola narodnog zdravlja "Dr. Andrija Štampar"; kvitale@snz.hr Afrić, Ivo; Primorsko-goranska županija, Upravni odjel za zdravstvenu zaštitu i socijalnu skrb, Rijeka Šuljić, Petra; Nastavni zavod za javno zdravstvo Primorsko-goranske županije, Rijeka Pavić, Tomo; Ministarstvo zdravstva i socijalne skrbi Republike Hrvatske, Zagreb vodoopskrba; sanitarna inspekcija; legislativa; Hrvatska water supply; sanitary inspection; legislation; Croatia Voda je jedan od čimbenika opstanka čovjeka i stoga predstavlja bogatstvo i dobro od općega interesa svake države. To ukazuje potrebu za intenzivnu brigu i nadzor vodoopskrbe, te primjenu tehnoloških postupaka pročišćavanja i dezinfekcije vode. U Hrvatskoj se putem sustava organizirane komunalne vodoopskrbe opskrbi oko 80% ljudi, a putem lokalnih vodovoda oko 260.000 korisnika ili 6% ukupne populacije. Vodu za piće iz individualnih izvora, bunara i cisterni koristi 14% ukupne populacije. Republika Hrvatska donijela je Zakon o sanitarnoj inspekciji 2009. godine kojim je uređena organizacija i ustrojstvo sanitarne inspekcije, te njezine nadležnosti i ovlasti. Budući da sanitarna inspekcija ima izuzetno široko polje djelatnosti, Zakon propisuje da je na 15.000 stanovnika potrebno zaposliti jednog inspektora, kako bi se zaštita zdravlja stanovništva kvalitetno mogla obaviti. Tako ukupni zbroj sanitarnih inspektora iznosi, i u operativi i administrativnim pozicijama, 258, te po postojećem kriteriju na razini cijele RH nedostaje samo 37 inspektora. Ipak ovi brojevi dovode u zabludu, jer gledajući distribuciju po županijama, situacija je daleko lošija, budući da na mjestu gdje se neposredno obavlja 80% sanitarnog nadzora nedostaje 101 inspektor. Trenutačno osnovni problem u upravljanju vodama i proizvodnji vode za piće su mala materijalna sredstva, te bi stoga veću pažnju trebalo posvetiti upravo zaštiti onoga što imamo, a sanitarna inspekcija u tome igra značajnu ulogu. Država bi i dalje trebala ulagati u edukaciju i organizaciju sanitarne službe, a njezin položaj treba ojačati kao integralni dio Ministarstva zdravstva i socijalne skrbi. Water is one of the main factors in the sustainability of human life and, therefore, an asset and public interest of every state. The preservation of water and intensive care of water supply systems with the application of new technologies is an integral part of health care quality. In Croatia 80% of the population is covered with drinking water from communal water supply systems, 6% is using water from small local water supply systems, and the remaining 14% of the population is using water from individual wells or cisterns. In Croatia, the Law on Sanitary Inspection was ratified at the beginning of 2009, and it regulates the organization and establishment of sanitary inspection, its competences and authorities. Since sanitary inspection covers an exceptionally wide area of expertise, the law defines the employment of one inspector per 15.000 inhabitants in order to have quality health protection. Today there are 258 inspectors in Croatia, combined on administrative and operative positions and indicating a shortage of only 37 inspectors according to the Republic of Croatia criteria. However, these numbers are misleading because the distribution on county level, where 80% of sanitary inspection is performed, is much worse, and there is a shortage of 101 inspectors. At the moment the main problem in water production and management in Croatia are financial resources. More attention should be headed to the protection of the existing water resources, and sanitary inspection plays a significant role in that process. Croatia should invest more in the education and organization of sanitary inspection, and strengthen its position within the Ministry of Health and Social Welfare. General hospital Zadar 2011-03-01 text pdf http://hrcak.srce.hr/65091 http://hrcak.srce.hr/file/97474 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.40 No.3-4; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:65092 2011-03-14 journal:31

Stafilokokni empijem i pneumotoraks u dojenčeta Staphylococcal empyema and pyopneumothorax in infants Raos, Miljenko; Dječja bolnica Srebrnjak, Zagreb; miljenko.dr.raos@zg.t-com.hr Marković, Jelica; Dječja bolnica Srebrnjak, Zagreb stafilokokna sepsa; empijem; piopneumotoraks; liječenje; dojenče staphylococcal sepsis; empyema; pyopneumothorax; treatment; infant U radu je prikazano 11-mjesečno dojenče sa stafilokoknom sepsom i empijemom desnoga prsišta. Liječenje je provedeno odgovarajućim antibiotikom, a torakocentezom odstranjen je u potpunosti gnojni sadržaj. Petoga dana liječenja razvio se tenzijski pneumotoraks, što je zahtijevalo provođenje negativne usisne drenaže. Liječenje empijema je u djelokrugu pedijatra i kirurga, a rana primjena drenaže pleuralne šupljine preduhitruje razvoj komplikacija. An 11-month-old infant with staphylococcal sepsis and empyema of the right thorax is presented. An adequate antibiotic therapy was administered, and purulent content was eliminated by thoracocentesis. On the 5th day of treatment, a tension pneumothorax developed, and negative succion drainage was performed. Empyema therapy is under the competence of the paediatrician and surgeon, and early performed drainage of pleural cavity can prevent the development of complications. General hospital Zadar 2011-03-01 text pdf http://hrcak.srce.hr/65092 http://hrcak.srce.hr/file/97476 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.40 No.3-4; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:65093 2011-03-14 journal:31

Spontana ruptura slezene u infekcijskoj mononukleozi: prikaz tri slučaja Spontaneous splenic rupture in infectious mononucleosis: report of three cases Milas, Ivo; Klinički bolnički centar Split, Odjel za infekcijske bolesti; ivommilas@gmail.com Lukšić, Boris; Klinički bolnički centar Split, Odjel za infekcijske bolesti Mladinov, Suzana; Klinički bolnički centar Split, Klinika za unutarnje bolesti Glavinić, Robert; Klinički bolnički centar Split, Klinika za dječje bolesti Beljan, Renata; Klinički bolnički centar Split, Institut za patologiju, forenzičku medicinu i citologiju Knežević, Samira; Opća bolnica Dubrovnik, Infektološki odjel infekcijska mononukleoza; ruptura slezene infectious mononucleosis; splenic rupture Prikazana su tri bolesnika sa spontanom rupturom slezene u infekcijskoj mononukleozi koji su uspješno izliječeni splenektomijom. Pojava boli u trbuhu, uz pad vrijednosti hemoglobina i hemodinamsku nestabilnost kod bolesnika s kliničkom slikom infekcijske mononukleoze, pobudila je sumnju na rupturu slezene, što je potvrđeno ultrazvučnim pregledom i/ili kompjutoriziranom tomografijom abdomena. Zbog hemodinamske nestabilnosti učinjena je splenektomija kao terapija izbora. U literaturi se opisuje sve više primjera uspješnog konzervativnog liječenja spontane rupture slezene u hemodinamski stabilnih bolesnika sa subkapsularnim hematomom, a bez rupture kapsule. We present three patients with spontaneous rupture of the spleen in infectious mononucleosis successfully treated with splenectomy. The occurrence of pain in the abdomen, together with a decline in the value of hemoglobin and hemodynamic instability in patients with clinical picture of infectious mononucleosis, aroused the suspicion of spleen rupture, which was confirmed by ultrasonography and/or computed tomography of the abdomen. Because of hemodynamic instability they underwent splenectomy as a treatment of choice. The literature describes many examples of successful conservative treatment of spontaneous splenic rupture in hemodynamically stable patients with subcapsular hematoma without capsule rupture. General hospital Zadar 2011-03-01 text pdf http://hrcak.srce.hr/65093 http://hrcak.srce.hr/file/97478 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.40 No.3-4; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:65094 2011-03-14 journal:31

Usporedba transvaginalnog ultrazvuka i laparoskopskog nalaza u procjeni dobroćudnih adneksalnih promjena Comparison of transvaginal ultrasonography and laparoscopy in benign adnexal masses assessment Njavro, Božidar; Opća županijska bolnica Požega, Služba za ginekologiju i porodiljstvo Njavro, Lana; Medicinski fakultet Sveučilišta u Zagrebu (studentica) transvaginalni ultrazvuk; laparoskopija; dobroćudne adnesalne promjene transvaginal sonography; laparoscopy; benign adnexal masses U razdoblju od 2003. do siječnja 2008. laparoskopom promjera 10 mm (Wolf GmbH, Germany) pregledano je ukupno 30 pacijentica s dobroćudnim adneksalnim promjenama.U svake pacijentice je prije operacije učinjena procjena promjene na adneksima transvaginalnom ultrazvučnom sondom frekvencije 6,5 MHz (Hitachi, Japan). Bilo je 10 (33,3%) pacijentica sa ektopičnom trudnoćom, 9 (30%) s endometriozom, 9 (30%) s paraovarijskom ili funkcionalnom cistom, te 2 (6,6%) s drugim dobroćudnim promjenama na adneksima. Nakon završne dijagnostičke procjene laparoskopijom, sve pacijentice, njih 30, uspješno su laparoskopski operirane (uglavnom enukleacijom ciste, ooforektomijom ili salpingektomijom). Sve su pacijentice otpuštene nakon kratke hospitalizacije i bez postoperativnih komplikacija. Dijagnostički postupak transvaginalnim ultrazvukom i laparoskopijom pokazao je značajnu korelaciju (p < 0,01) dijagnostičkog vrednovanja, dokazujući komplementarnost, točnost i sigurnost. Histopatološka potvrda pokazala je visoku značajnost (p < 0,01) i opravdanost izvođenog dijagnostičkog postupka. During the period from 2003 to January 2008 we treated a total of 30 patients with benign adnexal masses by laparoscopy with 10 mm endo-camera (Wolf GmbH, Germany). All of the patients were preoperatively evaluated by transvaginal ultrasonography with 6.5 MHz probe (Hitachi, Japan). There were 10 (33,3%) ectopic pregnancies, 9 (30%) endometriosis, 9 (30%) paraovarial and functional cysts, and 2 (6,6%) other benign adnexal masses. After the final diagnostic evaluation by laparoscopy, all the patients were successfully treated by operative laparoscopy (mostly cyst enucleation, oophorectomy or/and salpingectomy). All patients were dismissed after a brief hospitalization period and without perioperative complications. Diagnostic procedures by transvaginal ultrasonography and laparoscopy showed a significant correlation (p < 0,01) of diagnostic value, which proved them complementary, accurate, and safe. Histopatological verification was also highly significant (p < 0,01) and justified the performed procedures. General hospital Zadar 2011-03-01 text pdf http://hrcak.srce.hr/65094 http://hrcak.srce.hr/file/97480 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.40 No.3-4; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:65152 2011-03-15 journal:31

Flebektazija unutarnje jugularne vene: prikaz slučaja Internal jugular vein phlebectasia: case report Raos, Miljenko; Dječja bolnica Srebrnjak, Zagreb; miljenko.dr.raos@zg.t-com.hr Marković, Jelica; Dječja bolnica Srebrnjak, Zagreb flebektazija; unutarnja jugularna vena; dijete phlebectasia; internal jugular vein; child Flebektazija unutarnje jugularne vene rijetka je prirođena anomalija u dječjoj dobi a očituje se nabreknućem vrata tijekom Valsalvinog postupka, odnosno tijekom radnji koje dovode do porasta unutarprsnog tlaka. U radu prikazujemo osmogodišnjeg dječaka s flebektazijom desne unutarnje jugularne vene, koja se očituje od druge godine djetetovog života. Dijagnoza je postavljena magnetskom rezonancijom (MR angiografija). Flebektazija je asimptomatska. Roditelji nisu pristali na operativni zahvat i suglasni su s praćenjem anomalije. Internal jugular vein phlebectasia is a rare inborn anomaly in childhood, presented with an expansile cystic swelling in the neck, which becomes more prominent during the Valsalva's maneuvre performance, and whenever intrathoracic pressure is increased. In the present paper we present an eight-year-old boy with right internal jugular vein phlebectasia, which he has had since the age of two. Magnetic resonance (MR angiography) confirmed the diagnosis. Phlebectasia is asymptomatic. The parents did not agree with surgical treatment, but they have accepted monitoring the anomaly. General hospital Zadar 2011-03-01 text pdf http://hrcak.srce.hr/65152 http://hrcak.srce.hr/file/97563 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.40 No.3-4; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:65154 2011-03-15 journal:31

Amiloidoza kao uzrok sindroma karpalnog tunela kod bolesnika s kroničnim bubrežnim zatajenjem: prikaz slučaja Amyloidosis related carpal tunel syndrome in patients with chronic renal disease: case report Matoković, Damir; Opća županijska bolnica Požega, Odjel ortopedije; damirmatokovic@gmail.com Hašpl, Miroslav; Specijalna bolnica za ortopediju i traumatologiju, "Akromion", Krapinske Toplice Smilović, Joško; Opća županijska bolnica Čakovec, Odjel ortopedije Petrić, Petar; Opća županijska bolnica Požega, Odjel za hemodijalizu Škorvaga, Sanja; Opća županijska bolnica Požega, Odjel za laboratorijsku dijagnostiku sindrom karpalnog tunela; amiloidoza; hemodijaliza carpal tunnel syndrome; amyloidosis; hemodialysis Bolesnici s kroničnim bubrežnim zatajenjem imaju povišene vrijednosti AGE (krajnje produkte glikolizacije). AGE nastaju tijekom procesa glikolizacije i oksidativnim reakcijama, kao dio procesa kronične upale. Amiloidoza je česta komplikacija kod bolesnika s kroničnim bubrežnim zatajenjem, a posljedica je nemogućnosti izlučivanja β2-mikroglobulina. Vremenskim trajanjem hemodijalize povećava se broj bolesnika kod kojih se histološki može utvrditi amiloidoza. Trećina bolesnika koji idu na hemodijalizu manje od 4 godine ima histološke znakove amiloidoze, a redovito se javlja kod 90% bolesnika nakon 5-7 godina hemodijalize. U početnom stadiju prisutni su samo histološki znakovi bolesti, dok se klinički znakovi javljaju kasnije. Jedan od prvih kliničkih znakova amiloidoze je sindrom karpalnog tunela. Javlja se kod trećine bolesnika koji idu 5-10 godina na hemodijalizu, a nakon 20 godina hemodijalize gotovo 100% bolesnika ima sindrom karpalnog tunela. Iako sindrom karpalnog tunela ne dovodi do fatalnog ishoda, njegovim zanemarivanjem dolazi do oštećenja n. medianusa u karpalnom tunelu i atrofije mišića šake s teškim funkcionalnim ispadima. Naš bolesnik je liječen operativno i nakon završene rehabilitacije zaostao je dobar funkcionalni i anatomski rezultat. Zbog toga je pravovremeno dijagnosticiranje i dekompresija n. medianusa preduvjet za uspješno liječenje sindroma karpalnog tunela. Za razliku od „low-flux“ hemodijalizatora, novi „high-flux“ su više biokompatibilni i mogu odstraniti beta-2-mikroglobulin, pa se očekuju rjeđe komplikacije u smislu sindroma karpalnog tunela zbog amiloidoze kod bolesnika s kroničnim bubrežnim zatajenjem. Patients with CRF (chronic renal failure) have elevated AGE (advanced glycation end products). AGE are formed during glycation and oxidative stress, and accumulation of AGE occurs especially in CRF and plays a major pathogenic role. Amyloidosis is a common complication in patients with chronic renal failure. Amyloidosis develops due to impossible β2-microglobulin excretion. The number of patients with histologically demonstrable amyloidosis increases with the length of hemodialysis. Histologic signs of amyloidosis are found in one third and 90% of patients undergoing hemodialysis for up to 4 years and 5-7 years, respectively. Histologic signs alone are present initially, whereas clinical signs develop later. The carpal tunnel syndrome is one of the first clinical signs of amyloidosis. The syndrome develops in one third of patients undergoing hemodialysis for 5-10 years and nearly 100% of those treated by hemodialysis for 20 years. The carpal tunnel syndrome is not a fatal disease; however, if left untreated, it leads to median nerve lesion and atrophy of the hand musculature with severe functional deficits. The patient presented was operatively treated, followed by rehabilitation that resulted in satisfactory functional and anatomical outcome. Accordingly, timely diagnosis and median nerve decompression are the main preconditions for successful management of the carpal tunnel syndrome. In contrast to “low-flux” hemodialyzers, the new ”high-flux” devices offer appropriate biocompatibility and β2-microglobulin removal, thus a lower rate of complications such as carpal tunnel syndrome due to amyloidosis is expected in patients with chronic renal failure. General hospital Zadar 2011-03-01 text pdf http://hrcak.srce.hr/65154 http://hrcak.srce.hr/file/97566 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.40 No.3-4; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:65162 2011-03-15 journal:31

In memoriam. Akademik prim.doc.dr.sc. Petar pl. Baturić dr.med. (27.01.1928. - 09.09. 2010. Mrđen, Anamarija General hospital Zadar 2011-03-01 text pdf http://hrcak.srce.hr/65162 http://hrcak.srce.hr/file/97576 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.40 No.3-4; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:67584 2011-05-09 journal:31

7. kongres Hrvatskog društva za otorinolaringologiju i kirurgiju glave i vrata s međunarodnim sudjelovanjem Roje, Željka; Klinika za ORL, KBC Split Račić, Goran; Klinika za ORL, KBC Split Skitarelić, Neven; Opća bolnica Zadar, Odjel za ORL i MFK General hospital Zadar 2011-05-02 text pdf http://hrcak.srce.hr/67584 http://hrcak.srce.hr/file/100883 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.41 No.Suplement; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:70293 2011-07-08 journal:31

Koncept obiteljske medicine - sigurna budućnost Family medicine - A safe future Ivković, Snježana; Dom zdravlja zagrebačke županije; snjezanaivkovic1@gmail.com Cerovečki, Venija; Medicinski fakultet Sveučilišta u Zagrebu, Katedra za obiteljsku medicinu Ožvačić, Zlata; Medicinski fakultet Sveučilišta u Zagrebu, Katedra za obiteljsku medicinu Soldo, Dragan; Medicinski fakultet Sveučilišta u Zagrebu, katedra za obiteljsku medicinu Buljan, Nataša; Privatna specijalistička ordinacija obiteljske medicine Petriček, Goranka; Medicinski fakultet Sveučilišta u zagrebu, Katedra za obiteljsku medicinu Murgić, Lucija; Medicinski fakultet Sveučilišta u Zagrebu, Katedra za obiteljsku medicinu Sonicki, Zdenko; Medicinski fakultet Sveučilišta u Zagrebu, Katedra za medicinsku statistiku,epidemiologiju i medicinsku informatiku Katić, Milica; Medicinski fakultet Sveučilišta u Zagrebu, Katedra za obiteljsku medicinu obiteljska medicina; obiteljski liječnik; kvaliteta skrbi family medicine; family doctor; quality of care Cilj: Istražiti stavove pacijenata prema obiteljskoj medicini, odnosno ustanoviti pridonosi li obiteljska medicina kvalitetnijoj zdravstvenoj skrbi pojedinca i obitelji, kao i doznati razloge koji su važni za postojanje obiteljske medicine u zdravstvenom sustavu urbanih i ruralnih područja. Ispitanici i metode: U četiri gradske i četiri seoske ordinacije provedeno je presječno istraživanje. Anketama koje su ispunjavali pacijenti stariji od 18 godina prikupljeni su podaci o dobi, spolu, stručnoj spremi, te broju članova obitelji koji su u skrbi istog obiteljskog liječnika. Ispitanici su odgovarali na pitanje drže li da obiteljska medicina pridonosi kvalitetnijoj zdravstvenoj skrbi za pojedinca i obitelj, te što drže razlozima koji su važni za postojanje obiteljske medicine. Rezultati: Uzorak je sačinjavalo 960 ispitanika, od čega 428 (44,58%) muškaraca i 532 (55,42%) žene. Većina ispitanika (N = 382, 39,79%) bila je starija od 60 godina. 494 (51,46%) ispitanika registrirano je u seoskim, a 466 (48,54%) u gradskim ordinacijama obiteljske medicine. Većina ispitanika u seoskim ordinacijama imala je nižu stručnu spremu (N = 277, 56,07%), dok je većina ispitanika u gradskima ordinacijama imala srednju stručnu spremu (N = 302, 64,81%). Značajno veći udio ispitanika u seoskim ordinacijama (N = 145, 29,35%) naveo je da su svi članovi obitelji u skrbi istoga liječnika (χ 2 = 23,27, p < 0,001). Od 960 ispitanika, njih 736 (76.67%) u potpunosti se složilo da obiteljska medicina pridonosi kvalitetnijoj skrbi. Za 510 (53.13%) ispitanika najvažniji razlog postojanja obiteljske medicine bio je poznavanje pacijenta. Zaključak: Sukladno stavovima pacijenata obiteljska medicina osigurava cjelokupnu, kontinuiranu skrb za pacijenta i doprinosi kvaliteti zdravstvene skrbi u cjelini. Aim: To investigate patients’ attitudes regarding family medicine, their opinion on the contribution of family medicine to the quality of health care and their perception of family medicine advantages. Participants and methods: A cross-sectional questionnaire-based study was performed in four urban and four rural family practices. Patients aged 18 years or more provided data on their age, sex, educational level and proportion of family members who were in care of the same family doctor. Patients expressed their opinion on the contribution of family medicine to the quality of health care and their perception of family medicine advantages. Results: Out of 960 patients, 428 (44.58%) men and 532 (55.42%) women, 494 (51.46%) patients were registered in urban and 466 (48.54%) in rural family practices. Most of the patients (N = 382, 39.79%) were aged 60 years or more. The majority of patients in rural practices had finished primary school (N = 277, 56.07%) and the majority of patients in urban practices had finished secondary school (N = 302, 64.81%). A significantly higher proportion of patients in rural practices reported having one family doctor taking careof all family members (N = 145, 29.35%) (χ 2 = 23.27, p < 0.001), 736 (76.67%) patients fully agreed that family medicine contributes to higher care quality. For 510 (53.13%) patients, the main advantage of family medicine was knowing the patient. Conclusion: According to patients’ opinion, family medicine provides holistic, continuing care to patients and contributes to a higher quality of health care. General hospital Zadar 2011-07-06 text pdf http://hrcak.srce.hr/70293 http://hrcak.srce.hr/file/104662 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.41 No.1-2; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:70294 2011-07-08 journal:31

Promjene u varijabilitetu srčane aktivnosti tijekom radnih i neradnih noći Changes in heart rate variability during working and non-working nights Slišković, Ana; Sveučilište u Zadru, Odjel za psihologiju, Obala kralja Petra Krešimira IV, 2, 23000 Zadar; aslavic@unizd.hr Manenica, Ilija; Sveučilište u Zadru, Odjel za psihologiju, Obala kralja Petra Krešimira IV 2, 23000 Zadar varijabilitet srčane aktivnosti; rad u smjenama; cirkadijurni obrazac; simpatička i parasimpatička regulacija srčane aktivnosti heart rate variability; shift working; circadian pattern; sympathetic and vagal modulation of cardiac activity Cilj ovoga istraživanja bio je usporediti razine i obrasce varijabiliteta srčane aktivnosti tijekom noćne smjene i ekvivalentnog neradnog razdoblja noći. U ispitivanju je sudjelovalo osam medicinskih sestara s Odjela za kirurgiju, Opće bolnice Zadar. Dob ispitanica kretala se u rasponu od 25 do 33 godine. Ispitivanje je uključivalo kontinuirano registriranje srčane aktivnosti tijekom 10-satnog razdoblja noćne smjene (21.00 – 07.00 sati) i tijekom ekvivalentnog neradnog razdoblja. U skladu s očekivanjem, analize su pokazale razlike u razinama srčane aktivnosti između radnog i neradnog razdoblja. Pri tome su tijekom neradnih razdoblja utvrđene veće prosječne vrijednosti i veći varijabilitet R-R intervala, odnosno naglašeniji učinak parasimpatičke regulacije srčane aktivnosti. S druge strane, obrasci promjena i spektralne kompozicije srčane aktivnosti bile su slične tijekom dvaju ispitivanih razdoblja. Dobiveni rezultati ukazali su na izraženost cirkadijurnog obrasca promjena, odnosno parasimpatičku prevalenciju tijekom radnih i neradnih noćnih r zdoblja. S obzirom da normalan rad zahtjeva aktivnost simpatičkog dijela autonomnog živčanog sustava, indikativna je parasimpatička prevalencija u srčanoj regulaciji tijekom radnog noćnog razdoblja. Navedeno se prvenstveno odnosi na razdoblja od 04.00 do 06.00 sati za koje su utvrđene iste razine parametara varijabiliteta srčane aktivnosti. Općenito se može kazati da parasimpatička dominacija tijekom radnih noći ukazuje na različitost među radnim zahtjevima i trenutnim mogućnostima organizma da ih zadovolji, što predstavlja glavni izvor stresa kod noćnog rada. The aim of this study was to compare levels and patterns of heart rate variability during working night shifts and the same period of non-working nights. Eight nurses from the Surgical Department of Zadar Hospital, aged 25-33, participated in this study. The study included continuous recordings of cardiac activity during 10 hours of night-shift working (9.00 pm – 7.00 am) and during the equivalent non-working night periods. As expected, the analyses showed differences in the levels of cardiac activity between working and nonworking nights. Non-working nights were characterised by longer R-R intervals, higher variability indices and greater parasympathetic effects on cardiac activity, while their patterns of changes and spectral compositions were rather similar to those obtained during working nights. The obtained results showed the supremacy of the circadian pattern of changes, i.e. parasympathetic prevalence, during both working and non-working nights. Parasympathetic prevalence during night shift working seemed inappropriate since normal working implies sympathetic activity. This is particularly true for the periods between 4.00 and 6.00 am, when various parameters indicated almost the same level of arousal during working and non-working nights. Certainly, the lack of sympathetic activity and parasympathetic dominance during working nights represents a discrepancy between the work requirements and the momentary capabilities of the organism to meet them. Due to this, it represents a major source of stress in night-shift working. General hospital Zadar 2011-07-06 text pdf http://hrcak.srce.hr/70294 http://hrcak.srce.hr/file/104664 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.41 No.1-2; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:70295 2011-07-08 journal:31

Liječenje hipertenzivne bolesti u trudnoći Treatment of the pregnancy hypertensive disorders Habek, Dubravko; Klinika za ginekologiju i porodništvo Medicinskog fakulteta Sveučilišta u Zagrebu i Kliničke bolnice "Sveti Duh", Zagreb; dubravko.habek@os.t-com.hr Moslavac, Sandra; Poliklinika "Sunce" Zagreb, Interni odjel Čerkez-Habek, Jasna; Poliklinika "Sunce" Zagreb, Interni odjel hipertenzija; trudnoća; liječenje hypertension; pregnancy; therapy Liječenje hipertenzivne bolesti u trudnoći uključuje antihipertenzivnu terapiju, antikonvulzivnu profilaksu, kontroliranu ekspanziju volumena (onkotsku terapiju), liječenje poremećaja koagulacije, te dovršenje trudnoće. Ciljevi antihipertenzivne terapije jesu: smanjiti povišeni periferni otpor, povećati perfuziju tkiva, uključujući uteroplacentarnu i fetalnu perfuziju, te spriječiti eklamptični napad, razvoj progresije bolesti i HELLP sindroma. Preporučljivi antihipertenzivi jesu urapidil, nifedipin, labetalol, metildopa, dihidralazin i magnezijev sulfat. Oprezno onkotsko liječenje 6% hidroksietilškrobom ili dekstranima ima za cilj poboljš nje reducirane mikroperfuzije uteroplacentarnog bazena, izovolemičnu hemodiluciju, te tromboprofilaksu. Liječenje aspirinom nije pokazalo poboljšanje u perinatalnom ishodu. Niskomolekularni heparin se profilaktički preporučuje kod teške preeklampsije, teške kronične hipertenzije, nefropatije, transplantacije bubrega i antifosfolipidnih protutijela. Liječenje zahtijeva praćenje hemodinamskog i koagulacijskog statusa, te statusa fetoplacentarne jedinice biofizikalnim profilom i doplersonografskim nadzorom. The management of preeclampsia includes antihypertensive therapy, anticonvulsant prophylaxis, controlled volume expansion (oncotic therapy), treatment of coagulation disorders and termination of pregnancy. Antihypertensives include nifedipin, urapidil, labetalol, methyldopa, dihydralazine and magnesiumsulfat. Oncotic treatment with 6% hydroxyethyl starch or dextrans is used to improve the reduced microperfusion of the uteroplacental unit, isovolemic hemodilution, and thromboprophylaxis. Aspirin therapy failed to show any perinatal outcome improvement. Low molecular heparin is recommended as prophylaxis in severe preeclampsia, severe chronic hypertension, nephropathy, kidney transplantation, and antiphospholipid antibodies. The treatment requires monitoring of the maternal hemodynamic and coagulation status, and of the fetoplacental unit status by biophysical profile and doppler sonography control. General hospital Zadar 2011-07-06 text pdf http://hrcak.srce.hr/70295 http://hrcak.srce.hr/file/104666 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.41 No.1-2; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:70296 2011-07-08 journal:31

Neuroticizam u funkciji faza menstrualnog ciklusa Neuroticism in the function of the menstrual cycle phases Šimić, Nataša; Sveučilište u Zadru, Odjel za psihologiju, Krešimirova obala 2, 23000 Zadar; nsimic@unizd.hr neuroticizam; menstrualni ciklus; spolni hormoni neuroticism; menstrual cycle; sex hormones Cilj provedenog istraživanja bio je ispitati neuroticizam u funkciji različitih faza menstrualnog ciklusa. U ispitivanju longitudinalnog tipa sudjelovale su zdrave ispitanice s regularnim menstrualnim ciklusima. Za određivanje neuroticizma korištena je skala neuroticizma Eysenckovog upitnika ličnosti. Ispitanice su popunjavanje skalu u različitim fazama menstrualnog ciklusa (menstrualna, folikularna, ovulatorna, lutealna i predmenstrualna faza). Izraženiji neuroticizam u menstrualnoj i predmenstrualnoj fazi, u skladu je s očekivanjima, imajući u vidu sniženu razinu spolnih hormona u organizmu, te prisustvo somatskih simptoma i negativnih raspoloženja u navedenim fazama ciklusa. U ostatku ciklusa, tj. u folikularnoj, ovulatornoj i lutealnoj fazi evidentno je smanjenje neuroticizma. The aim of this investigation was to examine neuroticism in the function of different menstrual cycle phases. Healthy female subjects with a regular menstrual cycle took part in this longitudinal study. In order to determine the neuroticism level, the neuroticism scale of the Eysenck Personality Inventory was used. This scale was filled during different phases of the menstrual cycle (menstrual, follicular, ovulatory, luteal and premenstrual phase). A higher level of neuroticism during the premenstrual and menstrual phase of the cycle is to be expected, considering a reduction of sex hormones in the body, presence of somatic symptoms and negative moods in these phases of the cycle. A decrease in neuroticism is evident during the rest of the menstrual cycle, ie. during the follicular, ovulatory and luteal phases of the cycle. General hospital Zadar 2011-07-06 text pdf http://hrcak.srce.hr/70296 http://hrcak.srce.hr/file/104668 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.41 No.1-2; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:70297 2011-07-08 journal:31

Utjecaj Helicobacter pylori infekcije na vrijednost C-reaktivnog proteina u bolesnika sa stabilnom koronarnom bolešću The impact of Helicobacter pylori infection on C-reactive protein value in patients with stable coronary artery disease Ćićerić, Mia; KBC Split, Klinika za unutarnje bolesti Fabijanić, Damir; KBC Split, Klinika za unutarnje bolesti; damir.fabijanic@st.t-com.hr Banić, Marko; KBC Split, Klinika za unutarnje bolesti Kardum, Duško; KBC Split, Klinika za unutarnje bolesti Zekanović, Dražen; Opća bolnica Zadar, Interni odjel Bonacin, Damir; KBC Split, Klinika za unutarnje bolesti Bečić, Tina; Medicinski fakultet Sveučilišta u Splitu, studentica medicine ateroskleroza; C-reaktivni protein; H.pylori; koronarna bolest srca atherosclerosis; C-reactive protein; H. pylori; coronary artery disease Cilj: Ranija istraživanja ukazala su na moguću ulogu H. pylori infekcije u napredovanju aterosklerotskog procesa. Kao jedan od mogućih patofizioloških mehanizama istaknuta je kronična upala s posljedičnim povećanim stvara jem proaterogenog C-reaktivnog proteina. Cilj ovog istraživanja bio je procijeniti utjecaj H. pylori infekcije na vrijednost C-reaktivnog proteina u bolesnika sa stabilnom koronarnom bolešću srca (KBS). Ispitanici i metode: U istraživanje je bilo uključeno 100 bolesnika sa stabilnom KBS (stabilnom anginom pektoris) potvrđenom angiografijom koronarnih arterija (koronarografijom). Zbog objektivnog određivanja H. pylori infekcije svi su bolesnici bili podvrgnuti ezofagogastroduodenoskopiji. Vrijednost serumskog hs-CRP određivana je pomoću visoko senzitivnog eseja (Cobas Integra 700, Roche, Mannheim, Njemačka) s rasponom detekcije od 0,25 do 150 mg/l. Rezultati: U istraživanje je uključeno 27 (27%) žena (61,8 ± 10,3 god) i 73 (73%) muškaraca (63,9 ± 10,8 god.). H. pylori infekcija zabilježena je u 60 (60%) bolesnika. Između skupina bolesnika pozitivnih i negativnih na H. pylori nisu zabilježene statistički značajne razlike u osnovnim hematološko-biokemijskim i kliničko-demografskim parametrima. Također, između navedenih skupina nije zabilježena statistički značajna razlika vrijednosti serumskog hs-CRP. Naime, vrijednost hs-CRP u bolesnika pozitivnih na H. pylori bila je 5,5 (0,6 – 21,2) mg/l, a u negativnih na H. pylori 4,8 (0,3 – 17,3) mg/l (z = 1,225, p = 0,221). Zaključak: Osnovno zapažanje provedenog istraživanja je da H. pylori infekcija ne utječe na vrijednost serumskog hs-CRP u bolesnika sa stabilnom KBS. Aim: Previous studies have shown the possible role of H. pylori infection in the development and progression of atherosclerosis. Increased values of proatherogenic C-reactive protein (CRP) due to the chronic inflammation are emphasized as one of the possible pathophysiological mechanisms. The aim of this study was to estimate the influence of H. pylori infection on the value of CRP in patients with stable coronary artery disease (CAD). Patients and methods: The 100 patients with stable CAD confirmed by coronary angiography were enrolled in the study. Esophagogastroduodenoscopy was performed in all the included patients in order to determine H. pylori status. Serum hs-CRP value was estimated using high sensitivity essay (Cobas Integra 700, Roche, Mannheim, Germany) with detection range from 0.25 to 150 mg/L. Results: 27 (27%) women (61.8 ± 10.3 y) and 73 (73%) men (63.9 ± 10.8 y) were enrolled in the study. H. pylori infection was confirmed in 60 (60%) patients. There were no differences in laboratory, clinical and demographic parameters between H. pylori positive and H. pylori negative patients. Also, there were no differences in serum C-reactive protein values between these two groups of patients. The value of hs-CRP in H. pylori positive patients was 5.5 (0.6 – 21.2) mg/l regarding 4.8 (0.3 – 17.3) mg/l revealed in H. pylori negative patients (z = 1.225, p = 0.221). Conclusion: The main observation of the presented study was that H. pylori infection does not affect the value of serum hs-CRP in patients with stable CAD. General hospital Zadar 2011-07-06 text pdf http://hrcak.srce.hr/70297 http://hrcak.srce.hr/file/104670 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.41 No.1-2; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:70298 2011-07-08 journal:31

Nasilje nad starijim osobama u ustanovama Instutional abuse of the elderly Rusac, Silvia; Pravni fakultet Sveučilišta u Zagrebu, Studijski centar socijalnog rada, Katedra za socijalnu gerontologiju; srusac@pravo.hr Čizmin, Ana; Pravni fakultet Sveučilišta u Zagrebu, Studijski centar socijalnog rada, Katedra za socijalnu gerontologiji, studentica starije osobe; nasilje u ustanovama; čimbenici rizika; prevencija older persons; institutional abuse; risk factors; prevention Cilj ovoga rada je približavanje problematici nasilja nad starijim osobama u ustanovama zdravstvene i socijalne skrbi. Zlostavljanje starijih osoba može biti namjerno ili nenamjerno, pa stoga može izravno uzrokovati štetu starijoj osobi od strane formalnog njegovatelja/profesionalaca, kao i neosiguravanje osnovnih potreba ili zaštite starijih osoba od povrede. Ono uključuje psihičko, tjelesno, financijsko i seksualno zlostavljanje, te zanemarivanje. Rad prikazuje oblike nasilja, čimbenike rizika koji mogu dovesti do nasilnog ponašanja stručnjaka, pregled dosadašnjih istraživanja o ovom problemu i mjere prevencije koje mogu biti poduzete i koje su pojedine zemlje poduzele za suzbijanje zlostavljanja starijih osoba unutar takvih ustanova. Budući da u Republici Hrvatskoj tema nasilja nad starijim osobama u ustanovama još uvijek nije postala predmetom istraživanja, potrebno je osvrnuti se na postojeće međunarodne podatke i spoznaje koje naglašavaju važnost prevencije nasilja nad starijima od strane stručnjaka, potrebi zaštite starijih osoba i nužnost bavljenja ovom problematikom. The aim of this work is to approach the abuse issue of older persons in health and social care institutions. Abuse of the elderly can be intentional or non-intentional, and it can, therefore, cause damage to older people from the formal nursing attendant/professional, as well as the noninsurance of basic needs and protection of the elderly from injuries. This includes psychological, physical, financial and sexual abuse and negligence. This work shows the forms of abuse, risk factors that can bring to abusive professional behaviour, a view of past researches on this issue, prevention measures that can be taken and which some countries have taken in order to suppress abuse of the elderly in such institutions. Since the topic of institutional abuse of the elderly has not yet become a research issue in the Republic of Croatia, one needs to refer to international data and cognition which emphasize the importance of the perception of abuse of the elderly by professionals, the need for elderly protection and the need to engage in this matter. General hospital Zadar 2011-07-06 text pdf http://hrcak.srce.hr/70298 http://hrcak.srce.hr/file/104672 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.41 No.1-2; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:70321 2011-07-11 journal:31

Stečeni angioedem kao uzrok akutnog abdomena - prikaz slučaja Acquired angioedema as the cause for acute abdomena - case view Klarin, Ivo; Opća bolnica Zadar, Odjel za interne bolesti, Odsjek za gastroenterologiju,Bože Peričića 5, 23 000 Zadar Kozić, Mate; Opća bolnica Zadar, Odjel za interne bolesti, Odsjek za gastroenterologiju Nakić, Dario; Opća bolnica Zadar, Odjel za interne bolesti Santini-Dušević, Danijela; Opća bolnica Zadar, Odjel za interne bolesti, Odsjek za nefrologiju stečeni angioedem; akutni abdomen acquired angioedema; acute abdomen Prikazana je 51-godišnja bolesnica sa stečenim angioedemom – abdominalni tip, bez dokazane pridružene bolesti. Terapija androgenom Danazol dala je dobar klinički odgovor, uz popravljanja vrijednosti C4 komponente komplementa. Potrebno je daljnje praćenje zbog eventulne nemanifestne pridružene bolesti. A 51-year-old patient is shown with acquired angioedema – abdominal type, without approved associated illness. Androgen Danazol therapy provided a good clinical response along with the management of C4 component complement values. Further follow-up is needed for eventual non-manifestation of associated illness. General hospital Zadar 2011-07-06 text pdf http://hrcak.srce.hr/70321 http://hrcak.srce.hr/file/104720 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.41 No.1-2; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:70322 2011-07-11 journal:31

Atipična klinička prezentacija akutnog abdomena Atypical clinical presentation of an acute abdomen Jurić, Klara; Klinička bolnica Dubrava, Zagreb, Klinika za unutarnje bolesti Cavrić, Gordana; Klinička bolnica Merkur, Klinika za unutarnje bolesti, Zajčeva 19, 10 000 Zagreb; gcavric@yahoo.com Naumovski-Mihalić, Slavica; Klinička bolnica Merkur, Klinika za unutarnje bolesti Prkačin, Ingrid; Klinička bolnica Merkur, Klinika za unutarnje bolesti Nassabain, Khaled; Dom zdravlja Centar, Zagreb Bartolek, Dubravka; Klinika za traumatologiju, Zagreb, Odjel za anesteziju i intenzivno liječenje Živko, Marijana; Opća bolnica Virovitica, Odjel za unutarnje bolesti akutni abdomen; klinička prezentacija acute abdomen; clinical presentation Prikazali smo slučaj šezdesetogodišnjeg bolesnika s atipičnom kliničkom slikom akutnog abdomena. Bio je bezbolnog trbuha, uz očuvano, spontano pražnjenje crijeva. Atipičnoj prezentaciji akutnog abdomena kod našeg bolesnika mogli su pridonijeti prethodno preboljeli moždani udar i šećerna bolest. We have presented a case of a sixty-year-old patient with atypical clinical manifestations of acute abdomen: the abdomen was painless with preserved spontaneous bowel movement. Stroke and diabetes could contribute to such an atypical presentation. General hospital Zadar 2011-07-06 text pdf http://hrcak.srce.hr/70322 http://hrcak.srce.hr/file/104722 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.41 No.1-2; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:70323 2011-07-12 journal:31

Liječenje prijeloma proksimalne dijafize radiusa u odraslih: prikaz slučaja Treatment of fractures of the proximal radial diaphysis: case report Gašpar, Drago; OŽ bolnica Požega, Osječka 107, 34000 Požega; gaspar.drago@gmail.com Đurović, Dražen; Opća županijska bolnica Požega osteosinteza; radius; povreda radialnog živca screw and plate fixation; radius Prikazujemo slučaj 20-godišnjeg pacijenta s frakturom dijafize proksimalnog radiusa, uz angulaciju (AO-22-A2.2), liječenog kirurški dorzolateralnim pristupom, otvorenom repozicijom i osteosintezom s LC-DC pločom i kortikalnim vijcima, uz solidnu interfragmentarnu kompresiju. Cilj ovoga prikaza slučaja je ukazati na anatomsku i kiruršku složenost ove regije i moguću komplikaciju intraoperacijske lezije duboke grane radijalnog živca. Ovaj tip prijeloma nije čest i u odrasloj dobi liječi se operacijski u cilju uspostave uredne funkcije lakatnog i ručnog zgloba. Posebnost regije proksimalnog radiusa je u anatomskoj poziciji duboke grane nervusa radialisa koji prolazi kroz muskulus supinator. I uz dobru identifikaciju duboke grane nervus radialisa i nervus interosseuma dorsalis, njihove intraoperacijske lezije nisu rijetke, kao što prikazujemo i u ovom slučaju. Reported is the case of a 20 year-old male with AO-22-A2.2 fracture of the proximal radial diaphysis with angulation, treated by dorsolateral approach, open reposition and osteosynthesis with LC-DC plate and cortical screws with solid interfragmental compression. The aim of this case report is to illustrate the anatomical and surgical complexity of this region that may contribute to operative injury of the deep branch of the radial nerve. This type of fracture is not common and requires surgical procedure in adults in order to restore the proper function of the elbow and wrist. The position of deep branch of the radial nerve which passes through the supinator muscles is characteristic for the proximal radial region. Despite of good identification of the deep branch of the radial nerve and dorsal interosseus nerve, their intraoperative injury in not uncommon as illustrated in this case. General hospital Zadar 2011-07-06 text pdf http://hrcak.srce.hr/70323 http://hrcak.srce.hr/file/104724 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.41 No.1-2; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:70327 2011-07-11 journal:31

Uloga radnog terapeuta u rehabilitaciji oboljelih od šizofrenije Role of the occupational therapist in schizophrenia patients rehabilitation Radić, Saša; Dobrotvorno udruženje "Dobrobit", Švarcova 20, 10000 Zagreb; sasa.radic@zvu.hr Škrbina, Dijana; Zdravstveno veleučilište Zagreb, Studij radne terapije psihosocijalna rehabilitacija, radna terapija, shizofrenija; produktivne aktivnosti psychosocial rehabilitation; occupational therapy; schizophrenia; productive activities Mentalno zdravlje je esencijalni čimbenik za aktivno i neovisno funkcioniranje u svim aspektima života. Poremećaji mentalnog zdravlja značajno narušavaju svakodnevno življenje, te uzrokuju disbalans u tri područja čovjekovih aktivnosti: samozbrinjavanju, produktivnosti i slobodnom vremenu. Odabir, organiziranje i aktivna participacija u produktivnim aktivnostima pojedinca narušenog mentalnoga zdravlja značajno su ograničene i/ili onemogućene zbog smanjene motivacije, nemogućnosti zadovoljenja zahtjeva produktivnih uloga, smanjenih sposobnosti rješavanja svakodnevnih problema, narušenih socijalnih vještina, smanjenog uvida u vlastito stanje, te stigme mentalne bolesti koja narušava odnos radne okoline prema pojedincu. U liječenju osoba oboljelih od shizofrenije od velikog značaja je psihosocijalna rehabilitacija. Ona uključuje edukaciju bolesnika i obitelji o bolesti, plan sprječavanja recidiva bolesti, trening socijalnih vještina, strategije rješavanja problema, tehnike samokontrole i samousmjeravanja, radnu terapiju, profesionalnu rehabilitaciju, programe potpomognutog zapošljavanja, te rekreativnu, kao i razne oblike kreativne terapije. Cilj navedenih strategija psihosocijalne rehabilitacije je izgradnja vještina potrebnih za svakodnevni život i rad, uspješna socijalna (re)integracija, odnosno radno uključivanje, čime se prevenira i/ili smanjuje opterećenje pojedinca i društva kao cjeline. Dodatni značaj ovoj intervenciji je i činjenica da se ove bolesti javljaju na početku radne karijere pacijenata, pa je ovakav pristup od velike važnosti za ostatak njihovog radnoga vijeka. Od svih poremećaja mentalnoga zdravlja, shizofrenija je povezana s najvećom stigmatizacijom i diskriminacijom, stoga je svrha ovoga rada dati prikaz radno-terapijske intervencije u procesu psihosocijalne rehabilitacije osobe oboljele od shizofrenije. Prikaz iskustva psihosocijalne rehabilitacije je proizašao iz projekta „Prihvatimo različitosti, odbacimo predrasude“ Udruge za unapređenje duševnoga zdravlja i podizanja kvalitete života duševnog bolesnika i njegove obitelji „Sretna obitelj“ u Popovači, Hrvatska. Iako se intervencija pokazala uspješnom već u inicijalnim fazama provedbe, ostaje još prostora za daljnja znanstvena i stručna promišljanja i istraživanja koja bi ukazala na opravdanost šire primjene gore navedenoga koncepta u hrvatskom kontekstu. Mental health is an essential factor for active and independent functioning in all aspects of life. Mental health disorders significantly impair daily life and cause imbalance in three areas of human occupation; selfcare, productivity and leisure. Selection, organization and active participation in the productive activities of an individual with mental health problems are significantly restricted and/or disabled. This is due to reduced motivation in satisfying productive role requirements, reduced capability of dealing with everyday problems, poor social skills, reduced insight into one’s own condition and mental illness stigma which impairs the relationship between the working environment and the individual. Schizophrenia patients’ treatment is of great importance to psychosocial rehabilitation. sychosocial rehabilitation includes education of patients and families about the disease, plan to prevent recurrence, social skills’ training, problem solving strategies, self-control techniques and self-direction, occupational therapy, vocational rehabilitation, employment programs, various forms of recreational and creative therapies, all with the goal of building skills for everyday life and work, successful social (re) integration, or inclusion, which prevents and/or reduces theburden on individuals and society as a whole. Additional significance of this intervention is the fact that these diseases occur at the beginning of the patient’s working career, so this approach is of great importance for the rest of their lives. Of all mental health disorders, schizophrenia is associated with the greatest stigma and discrimination, therefore, the purpose of this study provides insight into the work and therapeutic intervention in the process of psychosocial rehabilitation of persons suffering from schizophrenia. The psychosocial rehabilitation description experience was conducted within the project "Accept differences reject the prejudices” by the "Happy Family" Association, Popovača, Croatia. Although interventions have proved to be successful in the initial stages of implementation, there remains room for further scientific and technical thinking and research that would indicate the reasons for a broader application of the above concepts in the Croatian context. General hospital Zadar 2011-07-06 text pdf http://hrcak.srce.hr/70327 http://hrcak.srce.hr/file/104729 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.41 No.1-2; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:70337 2011-07-11 journal:31

Tusigena sinkopa: prikaz slučaja Tussive syncope: case report Perić, Irena; Klinički bolnički centar Split, Klinika za plućne bolesti; Sinjska 3 a, 21000 Split, irena.peric1@st.t-com.hr Mijaljica, Goran; Hitna medicinska pomoć Metković Miše, Kornelija; Klinički bolnički centar Split, Klinika za plućne bolesti Gudelj, Ivan; Klinički bolnički centar Split, Klinika za plućne bolesti Pavličević, Ivančica; Medicinski fakultet Split, Odjel za obiteljsku medicinu tusigena sinkopa; smjernice tussive syncope; guidelines Tusigena sinkopa ili osjećaj prijeteće nesvjestice za vrijeme kašljanja, najčešće se javlja kod sredovječnih, umjereno pretilih muškaraca koji puše ili su bivši pušači. Razlozi zbog kojih muški spol i pretilost utječu na sklonost tusigenoj sinkopi nisu poznati. Većina pacijenata također pati od suhog kašlja, epizoda teškog kašlja, a prisutni su i znaci opstrukcijske plućne bolesti. Postoji niz mogućih mehanizama. Prvi mehanizam objašnjava da, kada osoba kašlje, dolazi do porasta intratorakalnog tlaka, koji ima za posljedicu akutni pad otjecanja venske krvi i krvnoga tlaka. Posljedično, dolazi do usporavanja moždanog krvotoka, što u konačnici dovodi do gubitka svijesti. Drugi mogući mehanizam podrazumijeva slabljenje moždane perfuzije, kao posljedice rasta tlaka likvora. Uz ove procese, sinkopu nalazimo i kod pacijenata sa sindromom hipersenzitivnog karotidnog sinusa, gastroezofagealne refluksne bolesti, itd. Tusigena sinkopa spada u skupinu situacijskih sinkopa koje se manifestiraju nakon određenih događaja: npr. defekacije, mikcije, gutanja ili kašljanja. Ovdje prikazujemo dijagnostičke smjernice na slučaju 45-godišnjeg pacijenta koji pati od tusigene sinkope i liječi se u Klinici za plućne bolesti Kliničke bolnice Split. Tussive syncope, or cough syncope, is most often found in middle-aged, moderately obese men, who smoke or have stopped smoking. The reason why the male gender and obesity are predisposing factors for cough syncope is unknown. The majority of patients also suffer from chronic cough, episodes of severe cough, and clinical evidence of obstructive pulmonary disease. There are several proposed mechanisms. The first is that when a person coughs, intrathoracic pressure rises and obstructs venous outflow, which results in an acute decrease of cardiac output and blood pressure. As a result, the cerebral flow also decreases, which finally causes loss of consciousness. A second possible mechanism is the decrease of cerebral perfusion, as a consequence of increased pressure of the cerebrospinal liquor. Besides these mechanisms, tussive syncope is also found in patients with hypersensitive carotid sinus syndrome, gastroesophageal reflux, etc. Tussive syncope is considered as one of the situational syncopes, which take place after certain processes: e.g. defecation, micturition, swallowing and coughing. We will present the diagnostic guidelines through the case of a 45 year-old patient with tussive syncope, treated at the Split University Hospital Department for Pulmonary Diseases. General hospital Zadar 2011-07-06 text pdf http://hrcak.srce.hr/70337 http://hrcak.srce.hr/file/104740 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.41 No.1-2; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:77238 2012-02-08 journal:31

Folna kiselina - što znaju i koliko ju koriste rodilje u Zadarskoj županiji What Zadar county women know of folic acid and how much they use it Vitale, Ksenija; Sveučilište u Zagrebu, Medicinski fakultet, Škola narodnog zdravlja "Andrija Štampar" Sović, Slavica; Sveučilište u Zagrebu, Medicinski fakultet, Škola narodnog zdravlja "Andrija Štampar" Milić, Marko; Specijalna bolnica za ortopediju, Biograd na moru; milichmarko@gmail.com Balorda, Ljilja; Zavod za javno zdravstvo Zadar Todorović, Goran; Dom zdravlja Velika Uhoda, Branko; Specijalna bolnica za ortopediju, Biograd na moru Folna kiselina; defekt neuralne cijevi; javnozdravstvena intervencija; dodaci prehrani; preporuke Folic acid; neural tube defect; public health intervention; supplementation; recommendations Cilj ovoga rada je utvrditi koliko su rodilje u Zadarskoj županiji upoznate s folnom kiselinom, te koliko su je uzimale. Iako je 80% od 339 ispitanica odgovorilo da zna što je folna kiselina i skoro 85% njih da vjeruje da je korisna, pravilno ju je uzimalo samo 16,5%, dok je 23% njih uzimalo neki multivitamin. Savjet da uzima folnu kiselinu dobilo je 49% ispitanica, i to skoro 90% njih od ljekarnika. Liječnici su savjetovali samo 2% ispitanica i od toga niti jednu s niskom stručnom spremom. Samoinicijativno je 39% ispitanica uzelo neki preparat. Logistička regresija pokazala je da su glavni prediktori za uzimanje folne kiseline planirana trudnoća i spontani prekid trudnoće i/ili mrtvorođenost. Negativni prediktor je pušenje. Žene s višom edukacijom više su konzumirale folnu kiselinu. Ispitanice s nižim obrazovanjem višestruko su u nepovoljnijem položaju, budući da nemaju dovoljno spoznaja, baš uslijed nedovoljnog školovanja, a socijalna mreža kojoj pripadaju nije dovoljno snažna, a niti zdravstveni sustav ne dopire do njih. Za pretpostaviti je da, dok to ne bude pravilo u EU, Hrvatska neće obogaćivati hranu folnom kiselinom, pa je potrebno iznaći pravilnu kombinaciju svih raspoloživih metoda kako bi se ženama u fertilnoj dobi u Zadarskoj županiji omogućio njezin pravilan unos. Integrativan pristup bi kroz edukaciju o prehrani, stilu života, te pravilnu suplementaciju folnom kiselinom, mogao utjecati na smanjenje incidencije DNC-a (defekta neuralne cijevi). Također, integrativni pristup podrazumijeva da treba iskoristiti dostupnost ljekarnika, utjecaj obitelji i prijatelja, ali svakako treba povećati dostupnost i savjetovanje kroz primarnu zdravstvenu zaštitu. The aim of this study is to establish what pregnant women in Zadar County know about folic acid (FA) and how much they were using it. Out of 339 women 16.5% took FA correctly, 23% took some multivitamin, despite the fact that 80% knew what is FA, and 85% believed that it is useful. Some recommendation got 49% of women, mostly from pharmacists, only 2% got recommendation from physicians, out of whom not a single women with lower education. 39% of women decided to take FA on their own. Logistic regression analysis showed that the strongest positive predictor for taking FA is planned pregnancy and spontaneous abortion or stillborn. Smoking is a negative predictor. Women with higher education took more FA. Women with lower education are in multiple adverse positions due to poorer general knowledge, weaker social network and poorer access to the health care system. Under the presumption that Croatia will not introduce mandatory FA food fortification, until it is obligatory in the EU, it is necessary to use a combination of all available methods in order to supplement all women in childbearing age in Zadar County. An integrative approach through education on nutrition and lifestyle along with right supplementation could lead to decreased neural tube defects. An integrative approach implies benefit from the availability of pharmacists, influence of family and friends and above all increased availability and recommendations of through the primary health care system. General hospital Zadar 2012-02-01 text pdf http://hrcak.srce.hr/77238 http://hrcak.srce.hr/file/114626 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.41 No.3-4; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:77241 2012-02-08 journal:31

Istovremeno kirurško ispravljanje haluksa valgusa i izobličenja ostalih prstiju stopala Simultaneous surgical correction of hallux valgus and lesser toes deformity Lucijanić, Ivica; Opća bolnica Karlovac, Služba za ortopediju; ivica.lucijanic@bolnica-karlovac.hr Cicvara-Pećina, Tatjana; KB Dubrava, Zavod za dijagnostičku i interventnu radiologiju, Zagreb Bićanić, Goran; Klinički bolnički centar Zagreb, Klinika za ortopediju Pećina, Marko; Medicinski fakultet Sveučilišta u Zagrebu Halkus valgus; deformacije ostalih prstiju stopala; kirurško liječenje; trodimenzionalna osteotomija Hallux valgus; lesser toe deformity; surgical treatment; three-dimensional osteotomy Svrha rada je prikazati rezultate istovremenog kirurškog liječenja haluksa valgusa i deformacije ostalih prstiju stopala. U Službi za ortopediju Opće bolnice Karlovac u razdoblju od 2000. do 2009. godine trodimenzionalnom (3-D) osteotomijom za haluks valgus (metoda po Lucijaniću), kombiniranoj s operacijom ostalih prstiju stopala, operirana su 74 pacijenta (87 stopala). Ispravljanje deformacija prstiju uključivalo je proksimalnu interfalangealnu resekcijsku artroplastiku, produživanje tetive dugog ekstenzora, resekciju baze drugog i trećeg prsta sa subtotalnom sindaktilizacijom. Weilova osteotomija je primijenjena u bolesnika s predugim drugim metatarzalnim kostima. Klinička i radiološka evaluacija operiranih bolesnika provedena je nakon prosječno 60,5 mjeseci (raspon 12-127 mjeseci). Prosječna dob pacijenata u vrijeme operacije bila je 56,5 godina (27-70 godina), a 97,3% su bile žene. Prosječni postoperacijski haluks valgus kut je značajno smanjen s 33,5° +- 8 na 11,4° +- 6,8, dok je intermetatarzalni kut značajno smanjen sa 14,3° +- 3,6 na 6,1° +- 3,2. Prosječno smanjenje prve metatarzalne kosti od 7,1 milimetara kompenzirano je plantarnim pomakom glave prve metatarzalne kosti u zoni osteotomije. Klinički parametri su značajno poboljšani prema AOFAS ljestvici s prosječno 37,1 +- 11,2 prijeoperativno na 87,8 +- 9,5 poslijeoperativno (p < 0,001). Rezultat je ocijenjen kao odličan i dobar u 85% slučajeva, uz 10 zadovoljavajućih i 3 loša ishoda. Komplikacije su uključivale recidiv deformacije u šest slučajeva. Jedan slučaj luksacije drugog metatarzofalangealnog zgloba je izazvao pogoršanje već prije prisutne metatarzalgije. Bio je jedan slučaj površne infekcije i jedan venske tromboze, dva tjedna nakon operacije. Rezultat ove studije potvrdio je Lucijanićevu metodu kao vrlo uspješnu u kirurškom liječenju umjerene do teške deformacije haluksa valgusa, a u kombinaciji s različitim postupcima kirurškoga liječenja deformacija ostalih prstiju, osigurava se potpuno ispravljanje glavnine poremećaja prednjega dijela stopala. The purpose of this study was to present results of simultaneous correction of hallux valgus and lesser toes deformity. In the Department of Orthopaedic Surgery, Karlovac General Hospital, between 2000 and 2009, 74 patients (87 feet) underwent new three-dimensional (3-D) osteotomy for hallux valgus (Lucijanić's method) combined with lesser toes surgery or lesser metatarsal osteotomy. Correction deformities included proximal interphalangeal resection arthroplasty, extensor tendon lengthening, resection of both bases of the second and third toes with a subtotal webbing of toes two and three (syndactylisation).The Weil osteotomy on the lesser metatarsal was performed in 11 cases with excess of the lesser metatarsal length. Clinical and radiological evaluation was performed with an average follow up of 60.5 months (range: 12-127 months). The average patient age at the time of surgical treatment was 56.5 years (27-70), 97.3% were women. The average hallux valgus angle significantly decreased from 33.5 +- 8 to 11.4 +- 6.8 while the intermetatarsal angle significantly decreased from 14.3 +- 3.6 to 6.1 +- 3.2. The first metatarsal distal articular surface angle was reduced in average from 16.8 +- 6.7 to -1.4 +- 7.4. The first metatarsophalangeal joint congruence of average 1.3 +- 0.9 grade was corrected to 0.2 +- 0.5. The sesamoid position was corrected from an average preoperative grade of 2.5 +- 0.7 to a grade of 0.4 +- 1.2 at final follow-up. The first metatarsal declination angle was increased from 22.6 +- 3.7 to 28.5 -+ 4.6. The first metatarsal pronation angle was corrected from 7.2 +- 6.9 to 0.2 -+- 5.6. The relative length of the first and the second metatarsals was reduced from 2.4 +- 3.7 to -4.7 +- 3.7 millimetres. The first metatarsal shortened an average of 7.1 millimetres compensated with plantar displacement of the metatarsal head at the osteotomy site. The preoperative AOFAS' hallux-metatarsophalangeal-interfhalangeal score averaged 37.1 +- 11.2 which increased significantly to 87.8 +- 9.4 postoperatively (p < 0.001). The overall outcome was rated as excellent and good in 85% of cases (10 fair, 3 poor). Complication included recurrence of deformity in six cases. Prolonged swelling was found in three cases. There were one case of superficial infection and one case of vein thrombosis two weeks after surgery. The results of this study confirmed the author's procedure as very useful surgical technique for correction of a moderate to sever hallux valgus deformity. Its combination with various procedures for lesser toes ensures complete correction of main forefoot disorders. General hospital Zadar 2012-02-01 text pdf http://hrcak.srce.hr/77241 http://hrcak.srce.hr/file/114630 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.41 No.3-4; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:77252 2012-02-08 journal:31

Pegilirani interferon alfa 2a (Pegasys) plus ribavirin, nasuprot interferonu alfa 2a (Roferon-A) plus ribavirin, u liječenju kroničnog aktivnog hepatitisa C Pegylated interferon alfa 2a (Pegasys) plus ribavirin versus interferon alfa 2a (Roferon-A) plus ribavirin in the treatment of chronic hepatitis C Zekanović, Dražen; Opća bolnica Zadar, Odjel za interne bolesti; dzekanovic@yahoo.com Dželalija, Boris; Opća bolnica Zadar, Odjel za suzbijanje i liječenje zaraznih bolesti Goll-Barić, Sanda; Roche d.o.o. Osijek Medić, Alan; Zavod za javno zdravstvo Zadarske županije, Služba za epidemiologiju, Zadar Kronični hepatitis C; nonresponderi; pegilirani interferon Chronic hepatitis C; non response; peginterferon alfa-2a Cilj ovoga istraživanja bio je usporediti učinkovitost terapije na trajni virološki odgovor (SVR) u bolesnika s kroničnim hepatitisom C liječenih pegiliranim (PEG) - interferonom alfa 2a, u kombinaciji s ribavirinom, nasuprot bolesnika liječenih konvencionalnim interferonom alfa 2a, u kombinaciji s ribavirinom, tijekom 48 tjedana, u bolesnika s kroničnim hepatitisom C, koji su prethodno bili neuspješno liječeni konvencionalnim interferonom alfa 2a (monoterapija). Metode. Bolesnici su podijeljeni u dvije skupine po 25 ispitanika. U skupini A 25 bolesnika, u razdoblju od 2003. do 2005. godine dobivalo je, tijekom 48 tjedana, konvencionalni interferon alfa 2a (Roferon A) u dozi od 6 MIU 3× tjedno, plus ribavirin, ovisno o tjelesnoj težini, 1000 mg ili 1200 mg dnevno. U skupini B 25 bolesnika, u razdoblju od 2005. do 2008. godine dobivalo je, tijekom 48 tjedana, pegilirani interferon alfa 2a (Pegasys) u dozi od 180 μg jednom tjedno uz ribavirin 1000 ili 1200 mg dnevno. Rezultati. Trajni virološki odgovor (SVR) u bolesnika skupne A bio je 16% u odnosu na 24% u skupini B. SVR je statistički značajno viši u skupini bolesnika inficiranih HCV genotipovima 2 i 3 u usporedbi s genotipom 1 (u skupini A 50%, nasuprot 5%, a u skupini B 57%, nasuprot 11%). Nuspojave tijekom liječenja bile su blagog ili umjerenog intenziteta, te nisu zahtijevale smanjenje doze lijekova ili privremeni prekid liječenja. Nakon prestanka terapije sve su nuspojave nestale. Zaključak. Dvojna terapija pegiliranim interferonom alfa i ribavirinom pokazala je statistički značajniji učinak na SVR od dvojne terapije konvencionalnim interferonom i ribavirinom u liječenju bolesnika s kroničnim hepatitisom C koji nisu odgovorili na monoterapiju konvencionalnim interferonom. The aim of this study was to determine the efficiency and safety of PEG interferon alfa 2a therapy in combination with ribavirin versus interferon alfa 2a therapy plus ribavirin (double therapy) for 48 weeks among chronic hepatitis C patients who were unsuccessfully treated with interferon alfa 2a or alfa 2b (monotherapy). Methods. There were two groups of patients. In group A there were 25 patients in the period from 2003 to 2005 who were given alfa 2a (Roferon A) in doses of 6 MIU three times a week together with ribavirin 1000 mg or 1200 mg daily for a period of 48 weeks. In group B there were 25 patients in the period from 2005 to 2008 who were given pegylated interferon alfa 2a (Pegasys) in weekly doses of 180 mg together with ribavirin of 1000 or 1200 mg for a period of 48 weeks. Results. The sustained viral response (SVR) in group A was 16% versus 24% in group B. SVR was statistically significantly higher in the group of patients infected with HCV genotypes 2 and 3 in comparison to genotype 1 (in group A 50% vs 5% and in group B 57% vs 11%). Both groups of patients had side effects that varied from mild to moderate, so that it was not necessary to lower the medicine doses or to stop with the therapy temporarily. All side effects disappeared when the treatment ended. Conclusion. Double therapy with PEG interferon alfa and ribavirin is more efficient than the double therapy with conventional interferon and Ribavirin in the treatment of chronic hepatitis C patients who did not respond to the monotherapy with conventional interferon. General hospital Zadar 2012-02-01 text pdf http://hrcak.srce.hr/77252 http://hrcak.srce.hr/file/114642 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.41 No.3-4; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:77256 2012-02-08 journal:31

Ultrazvučno vođena citološka punkcija čvorova na vratu Ultrasound-guided fine needle aspiration cytology of neck nodes Krišto, Branko; Županijska bolnica Livno, Odjel za ORL i cervikofacijalnu kirurgiju, Bosna i Hercegovina; branko.kristo@tel.net.ba Buljan, Marko; Županijska bolnica Livno, Odjel za ORL i cervikofacijalnu kirurgiju, Livno, Bosna i Hercegovina Ultrazvuk; citološka punkcija; čvorovi vrata Ultrasonography; fine needle aspiration citology; cervical nodes Uvod: Ultrazvučno vođena citopunkcija u dijagnostici čvora na vratu je studija dijagnostičke točnosti u koju su uključeni pacijenti koji su se klinički prezentirali sa čvorom na vratu. Studija je provedena kako bi se stekla objektivna procjena vlastitih iskustava u primjeni ove metode. Ispitanici i postupci: Istraživanjem je obuhvaćeno ukupno 180 pacijenata, starosti 6-89 godina, podjednako muškog (96) i ženskog spola (84). U svih je bolesnika učinjen ultrazvuk vrata, a potom ultrazvukom vođena citopunkcija. Rezultati citološke analize uspoređeni su s referentnim („zlatnim“) standardom, patohistološkim nalazom. Ovisno o citološkoj dijagnozi, bolesnici su retrogradno podijeljeni u dvije velike skupine: prvu skupinu činilo je 98 bolesnika kod kojih je citološki dijagnosticirana dobroćudna tvorba; drugu skupinu činili su bolesnici sa zloćudnom izraslinom na vratu, a podijeljena je u dvije podskupine: bolesnici s primarnim zloćudnim promjenama, koju je činilo 25 bolesnika i bolesnici sa sekundarnim (metastatskim) zloćudnim promjenama vrata koju je činilo 57 bolesnika. Rezultati: Epidemiološkom analizom ustvrdili smo značajno stariju životnu dob za skupine bolesnika s primarnim i sekundarnim zloćudnim promjenama u odnosu na bolesnike s dobroćudnim promjenama. U skupinama sa zloćudnim promjenama, primarnim i sekundarnim, muškarci su bili češće zastupljeni (1,5:1 u korist muškaraca), dok je zastupljenost u skupini s dobroćudnim promjenama bila podjednaka. U skupinama bolesnika sa zloćudnim promjenama, primarnim i sekundarnim, sve dijagnoze postavljene citopunkcijom potvrđene su patohistološkom obradom. U skupini bolesnika kojima je citopunkcijom utvrđena dobroćudna promjena u 14 (14,2%) slučajeva je dijagnoza, nakon patohistološke obrade, promijenjena u zloćudnu, dok je značajno više bolesnika ostalo s istom dijagnozom (84 ili 85,8%). Limfocitna hiperplazija je najučestalija dijagnoza utvrđena citopunkcijom, kod koje je, po učinjenom patohistološkom nalazu, dijagnoza promijenjena u zloćudnu. Analizirajući valjanost citopunkcije vođene UZV, ukupno gledano, utvrđena je osjetljivost od 92%, specifičnost 85,7% i točnost od 83,9%, dok je za skupinu bolesnika sa sekundarnim zloćudnim promjenama (metastazama) utvrđena osjetljivost od 90%, specifičnost 73,8% i točnost od 85,5%. Rezultati su usporedivi, približno slični onima iz većih kliničkih ispitivanja. Zaključak: Naši rezultati ukazuju kako je UZV vođena citopunkcija, uz sva svoja ograničenja, korisna metoda u dijagnostici čvora na vratu, te može u velikom broju slučajeva isključiti potrebu za ekscizionom biopsijom i patohistološkom obradom, a u slučajevima kada ne isključuje potrebu za drugim dijagnostičkim postupcima svakako usmjeruje daljnju medicinsku obradu. Navedeni rezultati daju nam za pravo potvrditi ispravnost algoritma u kojem se, nakon klinički ustvrđenog čvora na vratu, obavlja citološka punkcija pod kontrolom UZV, a citološka dijagnoza će usmjeriti daljnji dijagnostičko-terapijski postupak. Introduction: Ultrasound-guided fine needle aspiration cytology in the diagnosis of neck nodes is a study of diagnostic accuracy which includes patients who have clinically presented themselves having neck nodes. The study has been conducted in order to gain on objective evaluation of personal experiences in using this form of procedure. Patients and methods: This research was done on a total of 180 patients, aged 6-89, about equally male and female (respectively 98 and 84). Neck ultrasonography was done on all patients and, after that, ultrasound-guided fine needle aspiration cytology. The results of fine needle aspiration cytology were compared with the referential („golden“) standard, histopathological report. Dependent of fine needle aspiration cytology diagnosis, the patients were retrospectively divided into two large groups. The first group consisted of 98 patients whose cytologic diagnosis showed benign nodes; the second group was made up of patients with malignant nodes and they were further separated into two subgroups: patients with primary malignant nodes, made up a group of 25 patients, and those with secondary malignant nodes (metastasis) on the neck, made up a group of 57 patients. Results: Epidemiological analysis determined a much older age in patient groups of primary and secondary malignant nodes in relation to those patients having benign nodes. In the group of patients having malignant nodes, both primary and secondary, men were more frequently present, (1.5:1 in favour of men), while their presence in the group with benign nodes was equal to that of women. In groups of patients with malignant nodes, both primary and secondary, all diagnoses made by fine needle aspiration were confirmed by histopathologic diagnosis. In other groups suffering benign nodes determined by a fine needle aspiration, in 14 (14.2%) cases diagnosis was changed into malignant after histopathologic reports, but for the majority of patients the diagnosis remained unchanged. Reactive lymph node hyperplasia is the most frequent diagnosis determined by fine needle aspiration cytology, after which, having done the histopathologic diagnosis, it was changed into malignant. While analysing ultrasound-guided fine needle aspiration cytology on the whole, sensitivity of 92%, specificity 85.7% and accuracy 83.9% were determined with the group of patients with secondary malignant nodes (metastasis) 90% sensivity, 73.8% specificity and 85.5% accuracy were determined. Conclusion: Our results show that ultrasound-guided fine needle aspiration cytology is, with all its restrictions, a useful method in neck node diagnosis, and in many cases it can eliminate the need for excision biopsy and histopathological diagnosis. In cases when the need for other diagnostic proceedings is not excluded, it certainly sets the guidelines for further proceedings. The above mentioned results give us the right to confirm the exactness of the algorithm in which ultrasound-guided fine needle aspiration cytology is done after clinically affirmed neck nodes under ultrasound control, and the cytology is supposed to direct further diagnostic-therapeutical procedure. General hospital Zadar 2012-02-01 text pdf http://hrcak.srce.hr/77256 http://hrcak.srce.hr/file/114647 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.41 No.3-4; ISSN 0351-0093 (Print) hr

oai:hrcak.srce.hr:77257 2012-02-08 journal:31

Računalna navigacija pri ugradnji totalne endoproteze koljena Computer assisted total knee arthroplasty Butorac, Željko; Klinika za ortopediju Lovran Šestan, Branko; Klinika za ortopediju Lovran Gulan, Gordan; Klinika za ortopediju Lovran Mađarević, Tomislav; Klinički bolnički centar Rijeka, Klinika za kirurgiju; tomislav.madjarevic@gmail.com Artroza koljena; totalna endoproteza koljena; računalna navigacija Knee osteoarthritis; total knee endoprosthesis; computer navigation Artroza koljena je najčešća degenerativna bolest zglobova čija se incidencija povećava starenjem populacije. U uznapredovaloj fazi bolesti liječenje artroze koljena obuhvaća ugradnju totalne endoproteze koljena. Dugotrajnost preživljenja totalne endoproteze koljena ovisi o ispravnoj pozicioniranosti komponenata endoproteze u sve tri ravnine, odnosno o rekonstrukciji biomehaničkih odnosa donjeg ekstremiteta. Pogreške u kirurškoj tehnici najčešći su razlog nepreciznosti ugradnje komponenti totalne endoproteze koljena. Razvojem instrumentarija poboljšavaju se rezultati ugradnje endoproteze koljena, a značajan napredak postiže se uvođenjem računalne navigacije u kirurgiju koljena 1997. godine. Virtualnim povezivanjem anatomskih struktura, prvenstveno koštane anatomije pacijenta, s računalnom slikom istoga, koristeći podatke slikovnih pretraga ili anatomske intraoperativne podatke, svaka je kirurška akcija prikazana na ekranu u realnom vremenu na računalno oblikovanom modelu. Virtualna trodimenzionalna reprodukcija koljena uz pomoć računala omogućava preciznije reseciranje zglobnih površina i ugradnju komponenti endoproteze koljena. Precizna pozicioniranost dijelova endoproteze i rekonstrukcija biomehaničkih odnosa omogućava brži oporavak, agresivniju fizioterapiju, a i sam vijek endoproteze je produljen, čime se smanjuju troškovi zdravstvenog sustava i povećava zadovoljstvo pacijenta. Knee osteoarthritis is the most common degenerative joint disease, whose incidence increases as populations age. In advanced stages, knee osteoarthritis disease treatment considers the implantation of a total knee endoprosthesis. Longterm survival of total knee endoprosthesis depends on the correct positioning of prosthesis components in all three planes, with respect to the reconstruction of the biomechanical relations of the lower extremities. Mistakes in surgical technique are the most common reason for inaccurate implantation of the total knee endoprosthesis components. The development of instruments for total knee arthroplasty enhanced the results of total knee arthroplasty and significant progress was achieved with the introduction of the computer navigation system in knee surgery in 1997. Virtual linking of anatomical structures, primarily the bone anatomy of the patient, with computer images of the same, using image search data or intraoperative anatomic data, each surgical action is displayed on the monitor in real time on a computer-shaped model. Virtual three-dimensional reproductions of the knee using a computer system enable accurate resection of the articular surface and precise implantation of total knee endoprosthesis components. The precise positioning of total knee endoprosthesis components and the reconstruction of the biomechanical relations allow faster recovery, aggressive physiotherapy, and longer survival of endoprosthesis which reduce the cost of the health system and increase patient satisfaction. General hospital Zadar 2012-02-01 text pdf http://hrcak.srce.hr/77257 http://hrcak.srce.hr/file/114649 Medica Jadertina (opca-bolnica-zadar@zd.t-com.hr); Vol.41 No.3-4; ISSN 0351-0093 (Print) hr 1369036558577