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Malignant pleural mesothelioma (MPM) is an aggressive tumor that develops from the mesothelial cells lining the pleural cavity. The most relevant risk factor is asbestos exposure. Despite therapy the median survival is poor ranging from four to 18 months. The aims and objectives of this study were to assess the clinical characteristics and survival of patients with MPM treated at UHC Zagreb. This study included 101 patients diagnosed and treated for MPM at UHC Zagreb from September 1999 to September 2012. We analyzed the overall survival (OS), progression free survival (PFS) and OS depending on histological subtype, clinical stage, age, treatment method and pleurodesis performed using the Kaplan-Meier method. Eighty-nine patients were male and 12 female with the median age of 62 years. Using the TNM staging system, 69.3% were stage IV, 26.73% were stage III and 3.96% were stage II. 73.26% of MPM were epitheloid, 4.95% sarcomatous and 20.79% were NOS (non otherwise specified) histological subtype. 14.85% of patients had surgery, 55.44% of patients received chemotherapy and 9.9% radiotherapy. Median OS was 11 months and PFS was ten months. OS by histological subtype was 11 months for epitheloid, 12.5 months for NOS and 5.5 months for sarcomatous MPM. OS by TNM stage was seven months for stage II, 17.5 months for stage III and 11 months for stage IV disease. Median OS was longer for patients younger than 65 (12 vs. 8.5 months, p=0.28), patients treated with pleurodesis (13 vs. 7.5 months, p=0.06) and patients who received chemotherapy (12.5 vs. 7.5 months, p=0.10). The overall survival and prognosis of patients with malignant pleural mesothelioma in Croatia is poor in accordance with the literature. The studied treatment methods offer only a modest survival benefit to our patients.

Alvaradov sustav bodovanja osmišljen je radi smanjenja broja negativnih apendektomija. Rabi se u adultnoj i pedijatrijskoj populaciji, a broj negativnih apendektomija rijetko je manji od 10%. Kako bismo provjerili pou-zdanost metode, analizirali smo korelaciju Alvaradova sustava bodovanja i histološke dijagnoze djece apende-ktomirane zbog sumnje na akutnu upalu crvuljka. U retrospektivnoj studiji obuhvaćeno je 330-ero djece (Za-vod za dječju kirurgiju, KBC Zagreb), u razdoblju od siječnja 2014. do prosinca 2016. s kliničkom dijagnozom akutne upale crvuljka. Uključena su sva djeca neovisno o metodi apendektomije. Zbog nepotpune medicinske dokumentacije isključeno je 39-ero djece pa se u ovoj studiji analizira 291 dijete. Svaki je crvuljak postopera-tivno histološki pregledan u Zavodu za patologiju i citologiju KBC-a Zagreb i postavljena je konačna dijagno-za. U 160-ero djece preoperativno je načinjen ultrazvučni pregled trbuha te je zabilježena prisutnost ili odsut-nost znakova upale crvuljka. Od ukupno 291 histološki pregledanog crvuljka njih 35 (12%) bilo je bez znako-va upale, 44 (15,1%) bilo ih je u kataralnom stadiju upale, 153 (52,6%) flegmonozno, a 58 (19,9%) gangrenoz-no promijenjeno te je u jednog dječaka (0,3%) crvuljak bio perforiran. Srednja vrijednost (bodovnog iznosa prema Alvaradovu sustavu bodovanja) za djecu koja su imala histološki nalaz inocentnog (‘nevinog’) crvuljka i kataralne upale jest 6, za flegmonozne crvuljke 7, a gangrenozne 8. Dječak s perforiranim crvuljkom imao je zbroj bodova 6. Analizirane su osjetljivost, specifičnost i pozitivna prediktivna vrijednost kada je zbroj 7 i veći, a negativna vrijednost kada je zbroj 5 i manji. Osjetljivost Alvaradova bodovnog sustava u ispitivanoj skupini jest 68,9%, a specifičnost 52,9%. Pozitivna je prediktivna vrijednost 91,7%, a negativna 99%. Alvara-dov zbroj statistički je značajno veći u djece s flegmonoznom upalom crvuljka negoli kod onih s negativnim nalazom (p = 0,003) i kataralnom upalom (p = 0,007). Kod djece koja su imala gangrenoznu upalu crvuljka u odnosu prema inocentnim i kataralno promijenjenima također je statistički značajna razlika Alvaradova zbroja (p < 0,001). U djece s flegmonozno i gangrenozno upalno promijenjenim crvuljkom nema statistički značajne razlike Alvaradova zbroja (p = 0,054), kao ni kod histoloških dijagnoza kataralne upale i inocentnog crvuljka (p = 0,998). Od ukupnog broja apendektomirane djece u njih 160-ero (54,9%) načinjen je preoperativni ultraz-vučni pregled trbuha. Od svih ultrazvučnih nalaza njih 82 (51,2%) potvrđena su histološkom dijagnozom. Od ultrazvučnih nalaza koji nisu histološki potvrđeni bila su 64 (40%) lažno negativna i 14 (8,8%) lažno pozitiv-nih. Ultrazvučno pozitivan nalaz upalnih promjena crvuljka ima pozitivnu prediktivnu vrijednost 84,1%, a negativan nalaz 11,1%. Alvaradov sustav bodovanja u djece nije klinički pouzdan pokazatelj pozitivnih nalaza akutne upale crvuljka, ali ima visoku prediktivnu vrijednost negativnih apendektomija., The Alvarado scoring (AS) system was created with the intention to reduce the number of negative appendec-tomies. It is used in both the adult and pediatric populations, but the number of negative appendectomies is rarely lower than 10%. In order to test the reliability of the system, an analysis was done on the correlation of the Alvarado score and the histological diagnoses of children who underwent appendectomy for suspected acute appendicitis. This retrospective study was conducted at the Department of Pediatric Surgery of the Uni-versity Hospital Center Zagreb in the period between January 2014 and December 2016, and included 330 children with the clinical diagnosis of acute appendicitis. The children were included regardless of the method of appendectomy. As 39 of them were excluded due to incomplete medical records, only 291 children were analyzed. Each appendix was subjected to postoperative histological examination, after which the final diagno-sis was made. Abdominal ultrasound was performed in 160 children to detect whether there were signs of ap-pendicitis. 291 appendices were histologically examined, of which 35 (12%) were without inflammatory signs, 44 (15.1%) were in the catarrhal, 153 (52.6 %) in the phlegmonous, and 58 (19.9 %) in the gangrenous stage of inflammation; one boy (0.3 %) had a perforated appendix. The average value of the Alvarado score in children with histologically innocent or catarrhal appendix was 6, in those with phlegmonous 7, and in those with gangrenous 8. The boy with the perforated appendix had a score 6. Sensitivity, specificity, and positive predictive value (PPV) with the cut-point of 7, as well as negative predictive value (NVP) with the cut-point of 5, were analyzed. In the tested group, AS sensitivity and specificity were 68.9% and 52.9%, respec-tively. Positive predictive value was 91.7% and negative predictive value was 99%. AS was statistically signifi-cantly higher in children with phlegmonous appendicitis than in those with innocent appendix (p = 0.003) or with a catarrhal stage of inflammation (p = 0.007), as well as in children with gangrenous appendicitis com-pared to those with innocent and catarrhal appendicitis (p < 0.001). There was no statistically significant dif-ference between AS in children with phlegmonous and gangrenous appendicitis (p = 0.054), and neither be-tween AS in those with catarrhal and innocent appendix (p = 0.998). The abdominal ultrasound examination was performed preoperatively in 160 (54.9%) of all operated children. Only 82 (51.2%) of all ultrasound find-ings were consistent with the final histological diagnosis. Among those incongruous findings, there were 64 (40%) false negative and 14 (8.8%) false positive ones. Ultrasound showed the presence of appendicitis with a PPV of 84.1%, but for exclusion of the diagnosis NPV was 11.1 %. AS is not a reliable clinical indicator of the inflammatory signs of appendicitis in children, but still has a high predictive value for negative appendecto-mies.

Rak pluća najučestalija je zloćudna bolest u muškaraca, a pri vrhu je učestalosti i u žena. Među oboljelima 15% čine bolesnici s rakom pluća malih stanica. S obzirom na agresivnu prirodu ove bolesti i lošu prognozu, vrlo je važno definirati i implementirati standardizirani pristup dijagnostičkoj obradi, liječenju, kao i praćenju ovih bolesnika. Metode liječenja uključuju kemoterapiju, radioterapiju i, rijetko, kirurgiju ovisno o stadiju bolesti i općem stanju bolesnika., Lung cancer is the most common male cancer, and one of the most common female cancers. Small cell lung cancers account for 15% of lung cancers. Due to the aggressiveness of the disease and bad prognosis, it is important to define and implement standardized approach for diagnostics, treatment and monitoring of these patients. Treatment modalities include chemotherapy, radiotherapy, and, rarely, surgery according to the stage of the disease and patient condition.

Sinovijalna hondromatoza jest rijetka, benigna proliferativna bolest sinovijalne ovojnice zgloba, tetive ili burze koja u konačnici rezultira novostvorenim slobodnim tijelima. Za nju je tipično da zahvaća samo jednu lokalizaciju kod pojedinog bolesnika, a do danas su opisane 33 različite lokalizacije sinovijalne hondromatoze. U ovom je preglednom članku dan pregled literature o sinovijalnoj hondromatozi, a osobito su naglašene najnovije spoznaje o etiologiji, dijagnostici, diferencijalnoj dijagnostici i liječenju te bolesti. U radu se upozorava i na mogućnost maligne transformacije sinovijalne hondromatoze u sinovijalni hondrosarkom za koju je karakteristično da se javlja nakon višegodišnjeg tijeka bolesti obilježenog brojnim lokalnim recidivima. Na kraju se detaljnije osvrće na osobitosti češćih lokalizacija sinovijalne hondromatoze (rame, lakat, kuk, koljeno i gležanj) te se za svaku od tih lokalizacija iznose smjernice za izbor kirurškog liječenja., Synovial chondromatosis is an uncommon benign disorder of the synovial membrane of joints, tendon sheaths, or bursae characterized by the formation of multiple cartilaginous nodules or osseus loose bodies. It is usually a monoarticular disease, and 33 different localizations have been described until now. The aim of this review article is to present the newest knowledge on the etiology, diagnosis, differential diagnosis, and management of synovial chondromatosis. Malignant transformation to chondrosarcoma is an unusual but possible complication. It is closely connected with recurrence rate and usually occurs many years after surgical treatment. More specific details related to surgical treatment of most often affected joints, i.e. shoulder, elbow, hip, knee, and ankle are reported as well at the end of this review article.