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Uvod: Ljudski in vivo modeli oštećenja kože se koriste za ispitivanje djelotvornosti topikalnih terapija kožnih bolesti i oštećenja, među kojima se ističe model iritativnog dermatitisa induciranog natrijevim laurilsulfatom (SLS). Provođenje modela se uvelike razlikuje između različitih istraživačkih skupina, s različitim anatomskim lokacija na kojima su se istraživanja provodila. Osim navedenog modela koji predstavlja kemijsku iritaciju, često su korišteni modeli mehaničke iritacije tape-stripping postupkom te fizikalno oštećenje kože ultraljubičastim zračenjem. Cilj: Ispitati postojanje razlika u odgovoru kože na iritaciju i cijeljenje u akutnom modelu iritativnog dermatitisa izazvanog SLS-om na podlakticama i leđima te usporediti razlike u odgovoru kože na tri različita modela oštećenja kože u istim uvjetima, na istim ispitanicima te na istoj anatomskoj lokaciji. Materijali i metode: Provedena su dva randomizirana klinička pokusa. U pokusu 1 je na podlakticama i leđima inducirana iritacija SLS-om, uz kontrolnu iritaciju vodom. U pokusu 2 su na podlakticama inducirana oštećenja kože u tri različita modela oštećenja kože. U oba pokusa su praćene nastale promjene kožnih parametara neinvazivnim mjerenjima i oporavak kože, uz primjenu i bez primjene topikalne terapije. Rezultati: U pokusu 1, koža gornjeg dijela leđa je pokazala snažniju reakciju na iritanse, ali i brži oporavak kože. U pokusu 2, u modelu iritacije SLS-om je došlo do najsnažnijeg oštećenje kože i odgođene reakcije na iritans. Tape-stripping je doveo do najsnažnijeg početnog oštećenja kožne barijere, ali koža je nakon te nokse pokazala najbrži oporavak. Ultraljubičasto zračenje nije imalo učinka na funkciju kožne barijere, ali je dovelo do nastanka eritema i promjene razine melanina. Topikalne terapije u dva pokusa nisu dovele do poboljšanja mjerenih parametara kože. Zaključak: Osjetljivost kože na iritans i stopa oporavka kože nakon iritacije su ovisne o anatomskoj lokaciji. Tri ispitivana modela oštećenja kože su imala značajno različite učinke na parametre kože te različit oporavak nakon noksi., Introduction: Human in vivo models of skin damage are often used to test the effects of different topical treatments. Commonly used model is irritant contact dermatitis induced by chemical irritant, sodium laurylsulphate (SLS). There is no uniform approach to SLS testing, as different research groups use significantly different variations of the model, especially in regards to anatomical location where testing was conducted. Other commonly used skin damage models include tape-stripping as mechanical and ultraviolet radiation as physical skin damage model. Objective: The aim was to investigate differences in skin response to acute irritation induced by SLS and skin recovery between forearms and upper back, as well as to compare skin parameters in three different skin damage models on the same participants and anatomical location, in the same research conditions. Materials and Methods: Two randomized, controlled trials were conducted. In the trial 1, the skin irritation was induced using SLS on the forearms and upper back of the participants, with sham irritation, using water instead of SLS, as control. In the trial 2, the three skin damage models were induced on test sites on participants’ forearms. Changes in skin parameters and skin recovery in both trials were assessed using non-invasive bioengineering methods, with and without topical treatment. Results: In the trial 1, the skin of the upper back had significantly stronger reaction to irritant, as well as higher skin recovery rates. In trial 2, three tested skin damage models led to different changes of the skin parameters. Irritation by SLS induced the strongest skin damage and also showed delayed reaction to the irritant. The strongest initial barrier disruption was noted after tape-stripping. Also, tape-stripped skin had the highest recovery rates. Ultraviolet radiation did not have any effect on skin barrier function and only changed skin erythema and melanin values. Measured parameters were not improved by topical treatments in neither trial. Conclusion: The skin’s reaction to irritant and recovery was dependent on anatomical location. Three tested models had distinctive responses to skin damage and recovery.

Uvod: cilj ovog istraživanja je prikazati etiologiju akutnih crijevnih infekcija u bolesnika hospitaliziranih u Klinici za infektologiju KBC Split u razdoblju od 1. siječnja 2015. do 1. kolovoza 2016. godine. Cilj rada također je prikazati kliničku sliku, laboratorijske parametre, terapijske mjere primjenjene u ovih bolesnika te smrtne slučajeve nastale kao posljedica akutnih crijevnih infekcija. Materijali i metode: retrospektivno su prikupljeni podatci o etiologiji bolesti, dobi, spolu, trajanju hospitalizacije, kliničkoj slici, laboratorijskim parametrima, liječenju i ishodu liječenja u 259 bolesnika hospitaliziranih u Klinici za infektologiju KBC Split u razdoblju od 1. siječnja 2015. do 1. kolovoza 2016. godine. Podatci su prikupljeni u programu Microsoft Excell, a u obradi podataka koristili smo 2 (chi-square) test za nezavisne uzorke. Rezultati: u promatranom razdoblju bilo je 259 bolesnika s dijagnozom akutne crijevne infekcije. Prema dobnoj raspodjeli najviše bolesnika bilo je u dobnoj skupini iznad 60 godina (47%). Etiologija bolesti nije dokazana u 33% bolesnika. U skupini bolesnika s dokazanom etiologijom akutne crijevne infekcije najčešći uzročnik bio je Clostridium difficile (32%). U dobnoj skupini do 15 godina najčešći uzročnik je bio Rotavirus (23%). U dobnoj skupini od 15 do 60 godina najčešći uzročnik bio je Campylobacter spp. (27,7%), a u dobnoj skupini iznad 60 godina Clostridium difficile (54,5%). Prosječna duljina hospitalizacije bolesnika iznosila je 7,5 dana. Bolesnici s akutnom crijevnom infekcijom uzrokovanom s C. difficile imali su najdulju prosječnu hospitalizaciju (10,6 dana), dok su bolesnici s akutnom crijevnom infekcijom uzrokovanom Norovirusima imali najkraću prosječnu hospitalizaciju (2,7 dana). U promatranom razdoblju zabilježeno je sedam manjih epidemija. U četiri epidemije uzročnik nije dokazan, dok je Salmonella spp. bila uzročnik u preostale tri epidemije. Patološke primjese krvi i sluzi u stolici bile su najzastupljenije u bolesnika s akutnom crijevnom infekcijom uzrokovanom s Campylobacter spp. Ubrzana sedimentacija eritrocita i povišene vrijednosti leukocita, ureje i kreatinina najčešće su se javljale u bolesnika s akutnom crijevnom infekcijom uzrokovanom s C. difficile. U svih bolesnika primjenjena je dijeta i peroralna ili parenteralna rehidracija, a 60% bolesnika primalo je i antibiotsku terapiju. Od 259 bolesnika njih 245 (94,6%) je uspješno izliječeno, a 14 (5,4%) je preminulo. Svi smrtni slučajevi nastali kao posljedica akutne crijevne infekcije uzrokovani su s Clostridium difficile. 61 Zaključak: najčešći uzročnik akutnih crijevnih infekcija u djece je bio Rotavirus, u odraslih osoba Campylobacter spp., a u osoba starije životne dobi C. difficile. Zabilježeno je sedam epidemija, u četiri epidemije uzročnik nije utvrđen dok je Salmonella spp. dokazana kao uzročnik u preostale tri epidemije. Svi smrtni slučajevi nastali kao posljedica akutne crijevne infekcije uzrokovane su s C. difficile., Objective: the aim of this study is to present the etiology of acute intestinal infections in the patients who were hospitalized in the Clinical Department of Infectious Diseases at the Clinical Hospital Center Split in the period from January 1st 2015 until August 1st 2016. The aim of this study is also to present the clinical presentation, laboratory parameters, therapy measures applied in these patients and to present the death cases which were a result of acute intestinal infections. Matherials and methods: retrospectively were collected data on the etiology of the disease, age, gender, duration of hospitalization, clinical presentation, laboratory parameters, treatment and outcome of treatment in the 259 patients who were hospitalized in the Clinical Department of Infectious Diseases at the Clinical Hospital Center Split in the period from January 1st 2015 until August 1st 2016. Data were collected in the Microsoft Excell programme and in the processing of the data we have used the 2 (chi-square) test for indenpendent samples. Results: in the observed period we had 259 patients with the diagnosis of acute intestinal infection. According to the age distribution most patients were in the age group of older than 60 years (47%). Etiology of the disease hasn't been proven in 33% of patients. In the group of patients with proven etiology of acute intestinal infection the most common cause was Clostridium difficile (32%). In the age group under 15 years the most common cause of the disease was Rotavirus (23%). Campylobacter spp. (27,7%) was the most common cause in the age group of 15 to 60 years of age, while in the group aged older than 60 the most common cause was Clostridium difficile (54,5%). The average length of hospitalization was 7,5 days. The patients with acute intestinal infection caused by C. difficile had the longest average length of hospitalization (10,6 days), while patients with acute intestinal infection caused by Norovirus had the shortest average length of hospitalization (2,7 days). There were seven smaller epidemics noted in the observed period. The cause wasn't proven in four epidemics, while Salmonella spp. was the cause in the other three epidemics. The pathological 64 impurities of blood and mucus in the stool were most common in patients with acute intestinal infection caused by Campylobacter spp. The accelerated erythrocyte sedimentation rate and increased values of leukocytes, urea and creatinine were most common in patients with acute intestinal infection caused by C. difficile. The diet and oral or parenteral rehydration were applied in treatment of all patients and 60% of patients received antibiotic therapy. Out of 259 patients 245 (94,6%) were successfully cured and 14 (5,4%) had deceased. All death cases were a result of acute intestinal infection caused by Clostridium difficile. Conclusion: the most common cause of acute intestinal infections in children was the Rotavirus and in adults the Campylobacter spp., while in elderly people it was C. difficile. Seven epidemics were noted; in four epidemics the cause wasn't proven while Salmonella spp. was proven as a cause in three other epidemics. All the death cases incurred as a result of acute intestinal infection caused by C. difficile.

Percutaneous dilatational tracheostomy is a common surgical procedure that is becoming the method of choice in critically ill patients whenever prolonged airway secure and/ or ventilation support is needed. Although adverse events are relatively uncommon, serious life threatening complications can arise from this bedside procedure. We report a case of a 70-year-old female who developed extensive subcutaneous emphysema and bilateral pneumothorax immediately after a percutaneous dilatational tracheostomy procedure. Different mechanisms, such as damage to posterior or anterior tracheal wall, false passage or paratracheal placement or dislocation of the cannula are considered to be responsible for the development of pneumothorax and subcutaneous emphysema. Although bronchoscopic control after the tracheostomy procedure did not reveal any tracheal injury, we believe that subcutaneous emphysema and bilateral pneumothorax are most likely caused by procedure induced injuries of the trachea in addition to the applied high airway pressure induced by excessive or inappropriate ventilation. In our case report, we would like to emphasize that continuous bronchoscopic guidance during percutaneous tracheostomy is invaluable in decreasing the incidence of its overall complications, especially during enhancing the team experience., Perkutana dilatacijska traheotomija je učestali kirurški zahvat koji postaje metodom osiguravanja dišnoga puta u kritičnih bolesnika i bolesnika na dugotrajnoj mehaničkoj ventilaciji. Iako su popratni učinci relativno rijetki, metoda je vezana uz mogućnost nastanka za život opasnih komplikacija. Prikazujemo slučaj 70-godišnje žene kod koje je došlo do razvoja opsežnog potkožnog emfizema i obostranog pneumotoraksa neposredno nakon izvođenja perkutane traheotomije. Različiti mehanizmi kao što su oštećenje stražnjeg ili prednjeg zida dušnika, lažni prolaz ili paratrahealno postavljanje ili dislokacija kanile mogu se smatrati odgovornim za nastanak pneumotoraksa i potkožnog emfizema. U našem prikazu slučaja, iako nakon perkutane traheotomije bronhoskopskim pregledom nije nađeno oštećenje dušnika, smatramo da je uzrok nastanka potkožnoga emfizema i obostranog pneumotoraksa najvjerojatnije procedurom nastala ozljeda dušnika i primjena visokog tlaka u dišnim putovima izazvanog prejakom ili neodgovarajućom ventilacijom. Ovim prikazom slučaja željeli bismo naglasiti važnost bronhoskopske vizualizacije tijekom izvođenja perkutane traheotomije u prevenciji nastanka mogućih komplikacija, osobito u razdoblju usvajanja ove kliničke vještine.

Obstructive hydrocephalus is a relatively common complication of intraventricular hemorrhage resulting in high morbidity and mortality. We report two cases of transient obstructive hydrocephalus caused by obstruction of mesencephalic duct in patients that presented with altered consciousness which resolved spontaneously in a few hours. In very rare cases, obstructive hydrocephalus due to intraventricular hemorrhage may be transient and does not need neurosurgical or invasive procedures for lowering raised intracranial pressure, which otherwise are currently preferred treatment options., Opstruktivni hidrocefalus je relativno česta komplikacija intraventrikulskog krvarenja, što doprinosi visokom pobolu i smrtnosti. Cilj ovoga rada je prikazati dvoje bolesnika s prolaznim opsktruktivnim hidrocefalusom koji je uzrokovan opstrukcijom u području mezencefaličkog duktusa. Oboje bolesnika su se prezentirali prolaznim poremećajem stanja svijesti u trajanju od nekoliko sati. U rijetkim slučajevima opstruktivni hidrocefalus uzrokovan intraventrikulskim krvarenjem može biti prolazne naravi i tada nema potrebe za neurokirurškim ili drugim invazivnim postupcima radi sniženja povišenog intrakranijskog tlaka.

Naglo nastali bilateralni infarkti u područjima srednjih moždanih arterija javljaju se izrazito rijetko i često za posljedicu imaju smrtni ishod. Cilj je rada prikazati kliničku sliku bolesnice i pregled literature vezan uz naglo nastale bilateralne ishemijske moždane udare u irigacijskim područjima obiju srednjih moždanih arterija., Acute bilateral infarcts in the middle cerebral artery (lat. arteria cerebralis media - ACM) territories are very rare and can have a fatal outcome. The aim is to present the clinical picture of the patient, and the review of literature associated with bilateral stroke in middle cerebral artery territories.

We investigated concentrations and roles of insulin-like growth factor 1 (IGF-1) and its binding protein (IGF1BP-3), growth hormone (GH), insulin, and markers of insulin resistance and inflammation in acute myocardial infarction (AMI). We aimed to assess any possible association between serum GH/IGF-1 axis following AMI and short-term survival rates. A follow up study was performed in 2010. Study group consisted of 75 patients with Killip I and II class AMI. There were 30 control subjects. Blood samples were obtained within 24 hours of admission and analyzed for the aforementioned hormones. Patients were followed-up during 6 months for new cardiac events. Median GH was higher in AMI (0.96; range 0.6-2.4) than in controls (0.26; p, Istraživali smo uloge inzulinu sličnog čimbenika rasta (IGF-1), njegovog vezujućeg proteina (IGF1BP-3), hormona rasta (growth hormone, GH), inzulina, biljega inzulinske rezistencije i upale u akutnom infarktu miokarda (AIM). Cilj je bio utvrditi utjecaj osovine IGF-1/GH na kratkoročnu prognozu AIM. U istraživanje provedeno tijekom 2010. godine bilo je uključeno 75 bolesnika s dijagnozom AIM (ispitna skupina) i 30 ispitanika kao kontrolna skupina. Uzorci krvi su uzimani unutar 24 h od prijma i potom analizirani na navedene hormone. Tijekom šestomjesečnog razdoblja pratili smo hoće li doći do pojave novih srčanih događaja; ultrazvučno se određivala ejekcijska frakcija (EF). Medijan GH bio je veći u skupini s AIM nego u kontrolnoj skupini (0,96 prema 0,26; p

Svrha završnog rada ''Medicinska psihologija bolesti djeteta'' je doživljaj bolesti djece različitih dobnih skupina. Dok djeca predškolske te rane školske dobi bolest razumiju samo površno i na bolest gledaju kao odgovor na njihovo loše ponašanje odnosno kršenje pravila, djeca od 8 - 11 godina razdvajaju sebe od uzročnika bolesti. Djeca od 11 godina već obično razumiju fiziološke procese bolesti te vezu uzročnika i samih simptoma bolesti. Što se tiče samih reakcija djeteta, razlikujemo reakcije akutno te reakcije kronično bolesnog djeteta. Pritom su akutno bolesna djeca do 3 godine često razdražljiva i više ovisnija o roditeljima od starije djece. Kronično bolesna djeca na bolest reagiraju različito, ponajviše ovisno o dobnoj skupini. Reakcija kronično bolesnog djeteta sastoji se od reakcije na bolest, a osim toga i od reakcija na odvajanje od roditelja radi hospitalizacije, tjelesnih ograničenja, ovisnost o drugima, strah od liječenja, strah od bolova te ishoda liječenja. Sama hospitalizacija je štetna za emocionalni razvoj djeteta te je prilikom hospitalizacije vrlo važna komunikacija između liječnika i roditelja. Prilikom bolesti djeteta veliku ulogu igra i obitelj, koja također prolazi kroz više faza - šok i tjeskoba, odbijanje, srdžba te prilagodba, pri čemu dobra prilagodba znači bolju kvalitetu života te ujedno veću emocionalnu podršku djetetu. U slučaju da dijete boluje od neizlječive bolesti čija je posljedica smrt, reakcija djeteta različita je od jedne do druge dobne skupine. Pritom djeca do 2 godine ne poznaju pojam smrti. Temelje završnog rada ''Medicinska psihologija bolesnog djeteta'' čine značenje doživljaja bolesti u djetinjstvu, reakcije akutno i kronično bolesnog djeteta na bolest, reakcije djece koja boluju od neizlječivih bolesti te dječje poimanje smrti, korelacija bolesnog djeteta sa obitelji, komunikacija obitelji i liječnika te važnost pridržavanja uputa o liječenju te važnost medicinske sestre u liječenju bolesti djeteta.

The incidence of traumatic spinal cord injury is 11,000 per year, with 55% of the injuries occurring between the age of 16 and 33, 18% of these in women of reproductive age. Diagnostic and early spinal decompression along with maintaining the mean arterial pressure to improve spinal cord perfusion and a high progesterone level in pregnancy for its neuroprotective and anti-inflammatory effect have the leading role in neurological recovery and clinical outcome. We present a case of a patient in the 17th week of pregnancy who sustained luxation fracture of the C5 and C6 vertebrae and tetraplegia as passenger in a road accident. The early operative treatment and appropriate anesthetic procedure resulted in good clinical outcome with complete neurological recovery., Učestalost traumatskih ozljeda kralježnice je 11.000 na godinu, a 55% ozljeda nastaje u dobi od 16 do 33 godine, od toga 18% u žena reproduktivne dobi. Radiološka dijagnostika, uz ranu kiruršku dekompresiju kralježnice s održavanjem srednjeg arterijskog tlaka za očuvanje perfuzije leđne moždine, uz progesteron kao neuroprotektivni i protuupalni faktor u akutnoj traumi leđne moždine, ima vodeće mjesto u neurološkom oporavku i dobrom kliničkom ishodu. Donosimo prikaz slučaja trudnice u 17. tjednu trudnoće koja je zadobila luksacijsku frakturu petog i šestog vratnog kralješka s razvojem tetraplegije, kod koje su rano operacijsko liječenje i odgovarajući anesteziološki postupak doveli do dobrog kliničkog ishoda.

Akutna upala jezične tonzile neuobičajeni je uzrok jake grlobolje koji se u praksi vrlo rijetko dijagnosticira. Bolesnici s akutnom upalom jezične tonzile karakteristično se žale na jaku grlobolju, otežano gutanje i bolnost u razini hioidne kosti, a osobito je zanimljivo da bolesnici s prethodno učinjenom nepčanom tonzilektomijom pri ovoj bolesti mogu imati gotovo potpuno uredan nalaz orofarinksa. Diferencijalnodijagnostički potrebno je isključiti za život opasni epiglotitis. S obzirom na to da se korijen jezika ne može vizualizirati rutinskim orofaringoskopskim pregledom, dijagnoza se postavlja indirektnom ili transnazalnom fiberoptičkom laringoskopijom., Acute lingual tonsillitis is a rarely diagnosed cause of sore throat. The patient with acute lingual tonsillitis typically has severe sore throat, dysphagia and pain at the level of hyoid bone, and it is interesting that patients with previous palatine tonsillectomy can present with almost normal oral examination findings. The diagnosis of potentially fatal epiglottitis should be excluded. Because the base of the tongue can not be visualized by intraoral examination, diagnosis must be made by indirect or transnasal fiberoptic laryngoscopy.

Akutna bolest jednog od članova obitelji predstavlja značajni stresni životni događaj ili situaciju unutar obitelji. Iznenadna bolest stvara previranja na koja obitelj često ne može adekvatno odgovoriti ili se nositi s promjenama u zahtjevima funkcioniranja. Bez obzira o kojoj akutnoj bolesti ili stradavanju se radi, primjerice srčanom udaru, moždanom udaru, prometnoj nesreći, iznenadnoj bolesti i sl., ono predstavlja akutni životni događaj vezan uz prekid uobičajenog tijeka života unutar svakodnevice obitelji (Holmes-Raheova ljestvica stresnih događaja stavlja povredu ili bolest na šesto mjesto bodovanja stresnosti). Stres zbog bolesti člana obitelji uvijek je nasljednik dotadašnjih iskustava obiteljskog života i njene povijesti funkcioniranja i pokretač je promjena, kako u strategijama suočavanja, tako i u značenju bolesti koje obitelj pridodaje stresnom zbivanju. Bolest mijenja aktualnu obiteljsku situaciju samom činjenicom da se jedan član obitelji razbolio. Ozbiljnija tjelesna bolest najčešće je komplicirana neugodnim emocijama svih članova obitelji – anksioznošću i depresijom, prilagodbenim teškoćama i nesnalaženjem u promjeni i preraspodjeli uloga koje se nameću i pojavljuju unutar obitelji nakon razbolijevanja jednog od članova. Radi se zapravo o seriji stresova koji mogu izazvati psihološke i fiziološke stresne odgovore unutar obitelji kao cjeline. Svaka obitelj reagira adaptirajući se koliko je god to moguće iz njenih resursa u teškoj situaciji. Strategije suočavanja mogu biti različite: od aktivnog suočavanja, distanciranja, traženja socijalne podrške i prihvaćanja odgovornosti do izbjegavanja i negiranja problema. Liječnici koji neposredno liječe bolesnika najvažniji su u pružanju informacija obitelji jer time znatno smanjuju stresnost akutnih zbivanja i omogućavaju prevladavanje nesigurne i uzdrmane obiteljske situacije., Acute illness of a family member represents an important stressful event for the whole family. Usually, the family confronted with a sudden illness, cannot adequatly cope with new demands for change in functioning. No matter which acute illness or injuries are involved – heart attack, stroke or traffic accident, sudden illness is an acute life event associated with the termination of the usual course of everyday life within the family (Holmes – Rahe Scale of stressfull events puts the injury or disease to sixth place scoring stressfulness). Stress due to illness of a family member always is the succesor of the previous family life experiences and its history of driving changes, as well as the meaning of illness which family adds to new stressors. The fact that one family member became ill, changes the whole current family situation. Serious physical illness is often complicated by unpleasent emotion of all family members – anxiety, depression, adaptive difficulties and disorientation, as well as with a change in redistribution of roles that occurs within the family. It is actually a series of stresses that can cause psychological and physiological responses in most family members. Each family will react according to their specific resources. Coping mechanisms are various – from active coping, distancing, getting social support and taking responsability to avoidance or denial of the problem. Doctors who treat patients directly, are the most important in providing information to family members, reducing their anxieties and in such way helping them to overcome the unsafe and shaken family situation.

A 65-year-old man was referred to our department with clinical signs of septic shock and necrotizing soft tissue infection of the scrotal, perianal and right inguinal region. Initial presentation was a typical Fournier’s gangrene. Because of the life-threatening condition, the initial treatment was extensive removal of necrotic tissue. Antibiotic therapy was administered and several debridements of the wound were done afterwards. Three weeks after the initial treatment, wide wound defects of the perianal, scrotal and inguinal regions were closed secondarily and the patient was discharged from the hospital. Fournier’s gangrene is a surgical emergency. Although rare, it remains a life-threatening disease. Rapid and accurate diagnosis remains the key component in achieving successful outcome. Early aggressive surgical intervention together with fluid, hemodynamic and nutritional support and broad-spectrum antibiotics is the essential management to reduce mortality., Šezdesetpetogodišnji muškarac je primljen u našu ustanovu s kliničkom slikom septičkog šoka i nekroze u skrotalnom, perianalnom i desnostranom ingvinalnom području. Postavljena je dijagnoza Fournierove gangrene. Zbog lošeg općeg stanja bolesnik je odmah kirurški zbrinut, učinjena je opsežna nekrektomja. Antibiotska terapija je ordinirana, a nakon prve operacije je učinjeno nekoliko debridmana rane. Sedamnaest dana nakon operacije su postavljeni sekundarni šavi, a 23. dana bolesnik je otpušten na kućnu njegu. Fournierova gangrena je hitno kirurško stanje te, iako je rijetka, predstavlja tešku i za život opasnu bolest. Brza i točna dijagnostika uz agresivnu kiruršku terapiju i opetovane debridmane te antibiotici širokog spektra i dalje su ključ uspješnog liječenja.

Egzacerbaciju astme najčešće karakterizira brzo i progresivno pogoršanje simptoma ove bolesti: zaduhe, kašlja, piskanja i osjećaja pritiska u prsima. Intenzitet egzacerbacije može varirati od sasvim blagog, kratkotrajnog pogoršanja popraćenog podražajnim kašljem i blagom zaduhom pa sve do vrlo teškog, za život opasnog stanja. Klinička obilježja napadaja astme su ubrzano disanje, kašalj, produžen i otežan ekspirij. Opstruktivne smetnje disanja mogu se objektivizirati i pratiti mjerenjem plućne funkcije (PEF ili FEV1). Iznimno je važno što ranije prepoznati simptome egzacerbacije, procijeniti stupanj njezine težine te promptno započeti liječenje. Temelj terapije egzacerbacije astme čini ponavljana primjena inhalacijskih bronhodilatatora brzog djelovanja, rano uvođenje sustavnih glukokortikoida te adekvatna oksigenoterapija. Cilj je liječenja ublažiti stupanj bronhoopstrukcije i korigirati hipoksemiju što je prije moguće. Blaže egzacerbacije mogu se liječiti u izvanbolničkim uvjetima, dok teške treba liječiti u bolnici., Asthma exacerbation is characterized by a rapid and progressive worsening of symptoms, mainly dyspnea, cough, wheezing and chest tightness. The intensity of an exacerbation may vary form a mild, transient worsening marked by a cough and moderate shortness of breath to a very severe and life-threatening condition. The clinical features of asthma include increased rate of breathing, cough, and prolonged and difficult expiration. The expiratory flow limitation could be quantified, objectified, and monitored by the lung function measurements (PEF or FEV1). It is of crucial importance to recognize properly the early signs of an exacerbation, judge its severity, and promptly start the treatments. The strategy of the treatment of an asthma exacerbation includes the repeated administration of rapid-acting inhaled bronchodilators, the early introduction of systemic glucocorticoids and oxygen supplementation. The treatment is aimed to resolve the airflow limitation and ameliorate the hypoxemia, as quickly as possible. Mild exacerbations could be treated in general practice while the severe ones should be treated in emergence units.

Prikazan je slučaj kirurškog liječenja megakolona i njegovih komplikacija kod sedamnaestogodišnjeg mladića. Dovezen je u hitni kirurški prijam zbog boli u trbuhu i izostanka stolice zadnjih 7 dana. Saznaje se da je mladić od rane mladosti imao problema sa stolicom. Sfinkter kontrolira od 5. godine. Hospitaliziran je kao dijete, te mu je isključena dijagnoza kongenitalnog megakolona (patohistološki pregled biopsije rektuma uredna je nalaza). Od tada je defecirao svaki 4. do 5. dan, uz povremeno primanje laksativa. Nakon hospitalizacije na našem odjelu konzervativnim se metodama pokušala uspostaviti normalna peristaltika. Kako se stanje bolesnika pogoršavalo, napravljena je operacija po Hartmannu (resekcija sigmoidnog kolona). Postoperacijski je oporavak uredan te se devet mjeseci nakon prve operacije uspostavlja kontinuitet debelog crijeva. Mladić se redovito kontrolira i nema tegoba pri defekaciji., This case report examines the surgical treatment of megacolon and its complications in a 17-year-old male patient. He was examined in the surgical emergency unit because of severe abdominal pain and absence of stool for one week. Detailed history revealed that the patient had difficulties in defecation from the early childhood. Sphincter control was not established by the age of five. During hospitalzation as a child, the diagnosis of congenital megacolon was excluded (pathohistological examination of rectal biopsy material showed normal findings). He was followed-up regulary, had stool every four to five days and few times received laxatives to relieve constipation. The patient was hospitalized at the Department of Abdominal Surgery and primarily treated with conservative methods trying to induce intestinal peristaltics. As the patient’s condition worsened, Hartmann’s procedure was performed (sigmoid colon resection). Postoperative recovery was successful and after nine months we established colon continuity. The patient reports for check-ups without any difficulty in defecation.

Asthma exacerbation is characterized by a rapid and progressive worsening of symptoms, mainly dyspnea, cough, wheezing and chest tightness. The intensity of an exacerbation may vary form a mild, transient worsening marked by a cough and moderate shortness of breath to a very severe and life-threatening condition. The clinical features of asthma include increased rate of breathing, cough, and prolonged and difficult expiration. The expiratory flow limitation could be quantified, objectified, and monitored by the lung function measurements (PEF or FEV1 ). It is of crucial importance to recognize properly the early signs of an exacerbation, judge its severity, and promptly start the treatments. The strategy of the treatment of an asthma exacerbation includes the repeated administration of rapid-acting inhaled bronchodilators, the early introduction of systemic glucocorticoids and oxygen supplementation. The treatment is aimed to resolve the airflow limitation and ameliorate the hypoxemia, as quickly as possible. Mild exacerbations could be treated in general practice while the severe ones should be treated in emergence units.

Akutna bolest jednog od članova obitelji predstavlja značajni stresni životni događaj ili situaciju unutar obitelji. Iznenadna bolest stvara previranja na koja obitelj često ne može adekvatno odgovoriti ili se nositi s promjenama u zahtjevima funkcioniranja. Bez obzira o kojoj akutnoj bolesti ili stradavanju se radi, primjerice srčanom udaru, moždanom udaru, prometnoj nesreći, iznenadnoj bolesti i sl., ono predstavlja akutni životni događaj vezan uz prekid uobičajenog tijeka života unutar svakodnevice obitelji (Holmes-Raheova ljestvica stresnih događaja stavlja povredu ili bolest na šesto mjesto bodovanja stresnosti). Stres zbog bolesti člana obitelji uvijek je nasljednik dotadašnjih iskustava obiteljskog života i njene povijesti funkcioniranja i pokretač je promjena, kako u strategijama suočavanja, tako i u značenju bolesti koje obitelj pridodaje stresnom zbivanju. Bolest mijenja aktualnu obiteljsku situaciju samom činjenicom da se jedan član obitelji razbolio. Ozbiljnija tjelesna bolest najčešće je komplicirana neugodnim emocijama svih članova obitelji – anksioznošću i depresijom, prilagodbenim teškoćama i nesnalaženjem u promjeni i preraspodjeli uloga koje se nameću i pojavljuju unutar obitelji nakon razbolijevanja jednog od članova. Radi se zapravo o seriji stresova koji mogu izazvati psihološke i fiziološke stresne odgovore unutar obitelji kao cjeline. Svaka obitelj reagira adaptirajući se koliko je god to moguće iz njenih resursa u teškoj situaciji. Strategije suočavanja mogu biti različite: od aktivnog suočavanja, distanciranja, traženja socijalne podrške i prihvaćanja odgovornosti do izbjegavanja i negiranja problema. Liječnici koji neposredno liječe bolesnika najvažniji su u pružanju informacija obitelji jer time znatno smanjuju stresnost akutnih zbivanja i omogućavaju prevladavanje nesigurne i uzdrmane obiteljske situacije., Acute illness of a family member represents an important stressful event for the whole family. Usually, the family confronted with a sudden illness, cannot adequatly cope with new demands for change in functioning. No matter which acute illness or injuries are involved – heart attack, stroke or traffic accident, sudden illness is an acute life event associated with the termination of the usual course of everyday life within the family (Holmes – Rahe Scale of stressfull events puts the injury or disease to sixth place scoring stressfulness). Stress due to illness of a family member always is the succesor of the previous family life experiences and its history of driving changes, as well as the meaning of illness which family adds to new stressors. The fact that one family member became ill, changes the whole current family situation. Serious physical illness is often complicated by unpleasent emotion of all family members – anxiety, depression, adaptive difficulties and disorientation, as well as with a change in redistribution of roles that occurs within the family. It is actually a series of stresses that can cause psychological and physiological responses in most family members. Each family will react according to their specific resources. Coping mechanisms are various – from active coping, distancing, getting social support and taking responsability to avoidance or denial of the problem. Doctors who treat patients directly, are the most important in providing information to family members, reducing their anxieties and in such way helping them to overcome the unsafe and shaken family situation.

The aim of this study was to determine the incidence of acute angle-closure glaucoma in Split-Dalmatia County and correlation between visual acuity and time (days) elapsed from the disease onset to hospital admission. Twenty-nine cases were retrospectively analyzed. There were 19 female patients aged 36-91 (median age 68) years and 10 male patients aged 35-88 (median age 70) years, with attacks of acute closure glaucoma treated at University Department of Ophthalmology, Split University Hospital Center from January 2002 until December 2005. Annual incidence was 1.6 cases per 100,000. The time elapsed from the disease onset to hospital admission was 1-21 (median 2) days. Visual acuity before and after treatment was reversely proportional to the number of days to hospital admission (d=0.466; p=0.011). Visual acuity was found to depend on age as well (z=1.999; p=0.044). The best visual acuity was obtained in those cases that were admitted within two days (z=2.014; p=0.044). There was no significant sex difference in the incidence of angle-closure glaucoma (t=0.389; p=0.699). No statistically significant association was found between acute angle-closure glaucoma and seasonal variation (χ2=5; p=0.167). In conclusion, earlier recognition of the symptoms of acute angle-closure glaucoma and initiation of treatment within two days of the disease onset were associated with better visual acuity., Cilj ove studije bio je odrediti incidenciju akutnih napada glaukoma zatvorenog kuta u Splitsko-dalmatinskoj županiji te ispitati odnos između oštrine vida i broja dana od početka bolesti do hospitalizacije. Ova studija je provedena retrospektivno na 29 slučajeva. Bilo je ukupno 19 žena u dobi od 36 do 91 godine (medijan 68 godina) i 10 muškaraca u dobi od 35 do 88 godina (medijan 70 godina) s akutnim napadima glaukoma zatvorenog kuta liječenih na Očnoj klinici Kliničkog bolničkog centra Split od siječnja 2002. do prosinca 2005. godine. Godišnja incidencija iznosila je 1,6 slučajeva na 100.000. Vrijeme od početka bolesti do javljanja u bolnicu iznosilo je od 1 do 21 dana (medijan 2 dana). Oštrina vida prije i poslije operacije bila je obrnuto proporcionalna broju dana do prijma u bolnicu (d=-0,466; p=0,011). Oštrina vida nakon liječenja ovisila je o ranijem javljanju u bolnicu te o ranije započetom liječenju. Za krajnji ishod oštrine vida je uz ranije javljanje na liječenje bila važna i dob (z=1,999; p=0,044). Najbolju oštrinu vida nakon liječenja imali su oni bolesnici koji su hospitalizirani u prva dva dana (z=2,014; p=0,044). Nije bilo statistički značajne razlike u obolijevanju po dobi između žena i muškaraca (t=0,389, p=0,699), kao ni po godišnjem dobu (c2=5; p=0,167). U zaključku, ranije prepoznavanje simptoma i liječenje akutnog glaukoma zatvorenog kuta započeto u prva dva dana bilo je povezano s boljom vidnom oštrinom.

The objective of this prospective observational study was to determine and document the time elapsed from symptom onset to hospital admission in patients with acute stroke. The study was conducted at Emergency Department, University Department of Neurology, Split University Hospital in Split, Croatia, from October 1, 2004 to December 21, 2004, and included 115 patients with acute stroke. Data on the time of onset of stroke symptoms, brain computed tomography finding and current clinical status were noted. Fifteen patients were excluded from the study because the exact time of symptom onset could not be determined. A standardized interview with patients and/or their relatives was taken to collect the information needed. Ischemic stroke was diagnosed in 82 of 100 patients. Only 13 patients arrived in hospital within 3 hours of stroke symptom onset, and 29 were admitted to hospital more than 24 hours of stroke symptom onset. Sex had no significant effect on arrival time. It was concluded that the majority of patients with acute stroke did not present to emergency department within 3 hours of symptom onset, the current time window for thrombolytic therapy. It seems crucial to identify the factors associated with late presentation to the hospital. Public recognition of stroke symptoms and understanding of the importance of early hospital admission are mandatory for improving the results recorded in this study with time elapsed from symptom onset to hospital admission and eligibility for thrombolytic therapy taken as the main outcome measures. Additional public education is needed to increase awareness of the stroke warning signs., Cilj ove prospektivne opservacijske studije bio je utvrditi i dokumentirati vrijeme proteklo od nastupa simptoma do prijema u bolnicu kod bolesnika s akutnim moždanim udarom. Studija je provedena na Hitnom odjelu Klinike za neurolog¬iju, Kliničke bolnice Split u Splitu od 1. listopada 2004. do 21. prosinca 2004. godine i uključila je 115 bolesnika s akutnim moždanim udarom. Bilježili su se podatci o vremenu nastupa simptoma moždanog udara, nalazu kompjutorizirane tomografije mozga i aktualnom kliničkom statusu. Iz studije je isključeno 15 bolesnika u kojih se točno vrijeme nastupa simptoma nije moglo utvrditi. Proveden je standardizirani razgovor s bolesnicima i/ili njihovom rodbinom kako bi se dobile potrebne informacije. Ishemijski moždani udar je utvrđen u 82 od 100 bolesnika. Samo je 13 bolesnika stiglo u bolnicu unutar 3 sata od nastupa simptoma akutnog moždanog udara, a 29 ih je u bolnicu primljeno vi.e od 24 sata od nastupa simptoma. Spol nije imao značajnog utjecaja na vrijeme dolaska u bolnicu. Rezultati su pokazali kako većina bolesnika s akutnim moždanim udarom nije pristigla na hitni odjel unutar 3 sata od nastupa simptoma, što danas predstavlja vremen¬ski okvir za trombolitičnu terapiju. Od ključne je važnosti utvrditi čimbenike koji su povezani sa zakašnjelim dolaskom u bolnicu. Opće prepoznavanje simptoma moždanog udara i shvaćanje važnosti ranog prijema u bolnicu neophodno je za poboljšanje rezultata dobivenih u ovoj studiji, u kojoj su glavne mjere ishoda bili vrijeme proteklo od nastupa simptoma do prijema u bolnicu i podobnost za trombolitičnu terapiju. Potrebna je daljnja izobrazba javnosti kako bi se povećala svijest o upozoravajućim znacima moždanoga udara.

Intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) has recently reached the goal of becoming standard therapy in the acute stage of ischemic stroke in many countries. This appears to be one of the first pilot study reports from the region of Central and Eastern Europe. From January 1998 till October 2002, 56 consecutive patients underwent rt-PA thrombolysis at the University Department of Neurology, Nitra University Hospital, Slovakia. Selection criteria for the study were based on the NINDS study, with emphasis on the 3-hour therapeutic window. The mean baseline NIHSS wasR14.5, mean therapeutic interval 167 minutes, and mean intravenous rt-PA dose 0.7 mg/kg body weight. AtR3 months, mRS 0-1 was recorded in 33.9%, mRS 2-3 in 37.5%, and mRS 4-5 in 16.1% of study patients. Clinically relevant mRS 0-2 was achieved in 44.6% of study patients. The mortality was 12.5%. The rate of symptomatic and fatal intracerebral hemorrhage was 8.9% and 5.3%, respectively. Asymptomatic hemorrhagic transformation of a benign course was relatively frequently recorded (19.6%). Results of the study showed our stroke patients treated with intravenous rt-PA to have a favorable prognosis, and were comparable with those reported from the NINDS study and recent clinical studies., Intravenska tromboliza pomoću rekombinantnog aktivatora tkivnog plazminogena (rt-PA) odnedavno je postigla svoj cilj i u mnogim zemljama postala standardnim načinom liječenja akutnog stadija ishemijskog moždanog udara. Ovo je, čini se, jedno od prvih objavljenih probnih ispitivanja u području središnje i istočne Europe. U razdoblju od siječnja 1998. do listopada 2002. godine je na Klinici za neurologiju Sveučilišne bolnice Nitra iz Nitre, Slovačka, 56 uzastopnih bolesnika podvrgnuto trombolizi. Kriteriji za odabir bolesnika zasnivali su se na studiji NINDS, poglavito terapijski prozor od 3 sata. Postignuli smo prosječan bazalni NIHSS od 14,5, prosječan terapijski interval bio je 167 minuta, a prosječena doza intravenskog rt-PA bila je 0,7 mg/kg tjelesne težine. Nakon 3 mjeseca mRS 0-1 dostignulo je 33,9%, mRS 2-3 37,5%, te mRS 4-5 16,1% bolesnika. Klinički važan mRS 0-2 postiglo je 44,6% bolesnika. Smrtnost je bila 12,5%. Stopa simptomatskog unutarmoždanog krvarenja bila je 8,9%, a fatalnog 5,3%. Asimptomatska hemoragijska transformacija bila je relativno česta, tj. u 19,6% bolesnika s benignim tijekom. Zaključeno je kako bolesnici s moždanim udarom koji se liječe intravenskom rt-PA trombolizom u našoj bolnici imaju dobru prognozu, usporedivu s rezultatima studije NINDS i drugim novijim kliničkim studijama.

Rapidly progressive periodontitis (RPP) results from the interaction between the periodontal microflora and the host. Stress is believed to play an important role in determining host responses, and it has been proposed that hyperactivity of host defense mechanism significantly incresed tissue destruction tipical for this disease. During period of four months we have diagnosed 20 patients with acute RPP, all of them active participants in battles of the Croatian liberation war with posttraumatic stress disorder (PTSD) related simptoms. In these patients we analysed biochemical parameters in unstimulated saliva and performed microbiological analysis of periodontal pockets. These findings we compared with those of patients with adult periodontitis (AP), edentulous and healthy persons, none of whom participated in the war. Persons with AP had reduced concentrations of host humoral defense factors in saliva (C-reactive protein, C3 component of complement and alpha-2 macroglobulin), while patients with RPP had increased concentration of interleukin-6 (IL-6). IL-6 is released by host inflammatory cells and is mediator of bone resorption. Actinobacillus actinomycemcomitans and Peptostreptococcus were more frequently isolated in patients with RPP. We interpret these results as indicators of the importance of stress in causation of RPP, with host inflammatory hyperactivity playing an imporatnt role in tissue destruction, especially alveolar bone resorption, possibly caused by increased local levels of IL-6.